Laparoscopic removal of a tumor of the upper pole of the kidney with renal rotation around its vessels

Objective is to investigate the results of laparoscopic resection of tumors of the upper pole of the kidney using the method of renal rotation around its vessels.

Materials and methods. The analysis included results of surgical treatment of 12 patients with tumors of the upper pole of the kidney who underwent laparoscopic partial nephrectomy with rotation around the vascular pedicle. The kidney and its vessels were mobilized transperineally, then the kidney was rotated around its vessels in such a way that the upper pole containing the tumor was located in place of the lower pole. In this technique, dorsally located tumor was positioned frontally after rotation, making its subsequent resection more manageable. After tumor removal and hemostasis, the kidney was returned to its normal position.

Results. Using this technique, laparoscopic nephrectomy was possible in all patients. Mean duration of laparoscopic partial nephrectomy was 120.0 ± 35.0 (90–210) min, warm ischemia time – 14.5 ± 7.8 (10–26) min, blood loss – 120.0 ± 65.5 (60–300) ml. Pathomorphological examination revealed renal cell carcinoma in 11 (91.7 %) patients, renal angiomyolipoma – in 1 (8.3 %) patient. Follow-up duration was 6–24 months; during this time no local recurrence or distant metastasis were observed.

Conclusion. Use of renal rotation around its vascular pedicle expedites laparoscopic transperineal resection of dorsally located tumors of the upper pole and minimizes the number of intra- and postoperative complications.

kidney, tumor, cancer, surgery, kidney resection, partial nephrectomy, laparoscopy