Modified laparoscopic partial nephrectomy in treatment of giant cystic renal masses

Abstract:

Objective To investigate the efficacy and safety of modified laparoscopic partial nephrectomy combined with suction in the treatment of giant cystic renal masses.Methods A total of eleven patients with giant cystic renal masses were admitted，with a maximum tumor diameter of 60-130 mm and a mean diameter of （83±23） mm，and radiological examination showed Bosniak grade Ⅲ-Ⅳ cystic renal masses. During the procedure，the renal artery was separated under the laparoscopic visual field through a retroperitoneal or intraperitoneal approach，and the exophytic portion of the cystic mass was separated as much as possible. Then，a needle-shaped suction rod was used to suck out the cystic fluid at the thin area，and the needle hole was sutured or sealed. The tumor was further isolated completely，the renal artery was blocked，and partial nephrectomy was performed. The double-layer continuous suture technique was used for the suture of renal wound. Perioperative data and postoperative follow-up data were collected.Results All patients underwent a successful surgery，with no patients converted to open surgery or receiving radical treatment. The patients had a mean time of operation of （162±42） minutes，a mean warm ischemia time of （24.0±5.3） minutes，a mean blood loss of （107±79） mL，and a mean postoperative hospital stay of （6.7±1.7） days. Pathological examination showed clear cell renal cell carcinoma in seven patients，papillary renal cell carcinoma in one patient，xanthogranulomatous pyelonephritis in one patient，and benign complex cysts in two patients. No tumor recurrence or metastasis was observed during a median follow-up time of 21 months after surgery，and the patients had good renal function.Conclusion Modified laparoscopic partial nephrectomy combined with suction is a safe and effective method for the treatment of giant cystic renal masses and is suitable for Bosniak grade Ⅲ-Ⅳ cystic masses mainly with cystic components and a few septa.