• Vol. 38 No. 7, 576–580
  • 15 July 2009

Laparoscopic Partial Nephrectomy for Renal Tumours: Early Experience in Singapore General Hospital

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ABSTRACT

Introduction: To review the perioperative and short-term outcome of all laparoscopic partial nephrectomies (LPN) performed in a single institution. Materials and Methods: Thirteen consecutive patients who underwent LPN since the beginning of the programme in March 2002 to January 2008 were enrolled. Demographic, perioperative and follow-up data were retrospectively collected. Transperitoneal approach was used in all cases, and vascular control was achieved with the use of a laparoscopic Satinsky clamp or vascular tape. The tumour was excised using cold scissors. Transected intrarenal vessels were suture ligated and the parenchymal defect was closed primarily with absorbable suture over a bolster. Results: Thirteen patients underwent a total of 14 LPN. The median age of patients was 60 years (range, 41 to 77). The mean tumour size was 24 ± 11.4 (2SD) mm. The mean operative time was 228 ± 129 (2SD) minutes and median warm ischaemia time was 35 minutes (range, 24 to 68). Postoperatively, serum haemoglobin level decreased by a mean of 1.4 ± 2.5 (2SD) gm/dL and serum creatinine increased by a mean of 22.5 ± 25.8 (2SD) umol/L. Twelve out of 13 (92%) patients achieved their baseline serum creatinine level within 1 month postoperatively. There was 1 open conversion (7%), and 2 patients (14%) required blood transfusion perioperatively. Two patients (14%) had transient fever postoperatively due to basal atelectasis. No other complications were encountered. Median patient hospital stay was 4 days (range, 2 to 10). Eleven out of 14 (79%) of the tumours were renal cell carcinoma (RCC). At a median follow-up of 12 months (range, 6 to 53), all except 1 patient with RCC were disease-free. Conclusions: Our experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique in our centre for patients with small exophytic renal tumours. Patients can be discharged early with preservation of renal function and good early cancer control.


With the increasing availability of ultrasound and computed tomography scans, more patients are being diagnosed with incidental renal tumours. Up to 80% of tumours <4 cm turn out to be RCC upon histological examination.1 Nephron sparing surgery (NSS) is an established curative treatment in patients with single, small (4 cm) and localised RCC.2,3

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