Laparoscopic partial nephrectomy of solitary kidneys

Czech version

Authors: Jiří Kolář ¹; Petr Stránský ¹; Tomáš Pitra ¹; Adriena Bartoš Veselá ¹; Jiří Ferda ³; Ondřej Hes ²; Milan Hora ¹
Authors‘ workplace: Urologická klinika LF UK a FN Plzeň ¹; Šiklův ústav patologie LF UK a FN Plzeň ²; Klinika zobrazovacích metod LF UK a FN Plzeň ³
Published in: Ces Urol 2021; 25(2): 120-130
Category: Original Articles

Overview

Kolář J, Stránský P, Pitra T, Bartoš Veselá A, Ferda J, Hes O, Hora M. Laparoscopic partial nephrectomy of solitary kidneys.

Aim: To evaluate laparoscopic partial nephrectomies (LPN) of solitary kidneys performed at our Department and to compare the data with, and the results of, their open counterparts in the literature.

Material and methods: A retrospective analysis of patients who underwent LPN of solitary kidney during the years 2007–2020.

Results: In the time period 1/2007–5/2020 our Department conducted a total of 592 LPN with 10 cases (1.7 %) of solitary kidney resections (for comparison – in the same time frame 42 open solitary kidney resections (5.8 %) were conducted from a total of 725 open partial nephrectomies). The average age of patients who were indicated for LPN of a solitary kidney was 66 years (56–77 years). In the past, eight of them underwent contralateral nephrectomy due to tumour, in one case the kidney was functionally-solitary and in another there was an agenesis of the kidney. The duration of laparoscopy was on average 91 minutes (55–155 minutes), the hilum was clamped in 7 cases, in which the average warm ischemia time lasted for 12 minutes (7–23 minutes). The average size of the tumour indicated for laparoscopy was 22.7 mm (12–35 mm), the highest RENAL nephrometry score was 7a. Among histological findings there were 9 cases of clear cell renal cell carcinomas (8× pT1a, 1× pT3a), in one case a papillary renal cell carcinoma (pT1a) was diagnosed. Positive surgical margin (pR1) was found in one case. Once, a conversion to open surgery was required in order to achieve oncological radicality. In the immediate aftermath of the surgery there was no major decline in renal function. To date, there has been no need to apply renal replacement therapy in case of renal failure. In all surgeries including the postsurgical period no complications occurred. During the follow-up (average 51 months) there was no local recurrence of the tumour, once metastatic disease was described four months after the surgery.

Conclusion: In the time period 1/2007–5/2020 we conducted a total of 52 solitary kidney partial nephrectomies with laparoscopic approach in 10 cases (19.2 %). In the hands of a skilled surgeon LPN of solitary kidney represents, in specific cases, a safe alternative to open surgery.

Keywords:

laparoscopy – Partial nephrectomy – renal tumour – solitary kidney – warm ischemia time

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