Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: A non-ischaemic coagulative technique

Ilia S. Zeltser, Saurabh Moonat, Sangtae Park, J. Kyle Anderson, Jeffrey A Cadeddu

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE: To report the first intermediate-term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF-LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney. PATIENTS AND METHODS: A prospective database was searched to identify patients treated with RF-LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks. In all, 32 tumours were treated with this approach, and a radiographic follow-up was completed yearly. RESULTS: All PNs were accomplished with no hilar clamping, with a mean blood loss of 80 mL; 72% of masses were renal cell carcinoma. There was a positive margin in four masses (13%); 29 tumours (mean size 1.9 cm) were eligible for analysis of oncological outcomes, with a mean follow-up of 31 months. There were no tumour recurrences at the last follow-up, giving a cancer-specific survival rate of 100%. CONCLUSIONS: RF-LPN with no hilar clamping simplifies the surgical technique and appears to have excellent cancer control in the intermediate term. In the few patients with a positive surgical margin, it is possible that coagulation beyond the tumour margin kills any residual microscopic tumour, minimizing or obviating the risk of tumour recurrence. Nevertheless, vigilance during tumour excision and margin identification is mandatory.

Original languageEnglish (US)
Pages (from-to)36-38
Number of pages3
JournalBJU International
Volume101
Issue number1
DOIs
StatePublished - Jan 2008

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Nephrectomy
Neoplasms
Constriction
Kidney
Recurrence
Warm Ischemia
Fibrin Tissue Adhesive
Residual Neoplasm
Hemostatics
Renal Cell Carcinoma
Survival Rate
Databases

Keywords

  • Partial nephrectomy
  • Radiofrequency ablation
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy : A non-ischaemic coagulative technique. / Zeltser, Ilia S.; Moonat, Saurabh; Park, Sangtae; Anderson, J. Kyle; Cadeddu, Jeffrey A.

In: BJU International, Vol. 101, No. 1, 01.2008, p. 36-38.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To report the first intermediate-term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF-LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney. PATIENTS AND METHODS: A prospective database was searched to identify patients treated with RF-LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks. In all, 32 tumours were treated with this approach, and a radiographic follow-up was completed yearly. RESULTS: All PNs were accomplished with no hilar clamping, with a mean blood loss of 80 mL; 72{\%} of masses were renal cell carcinoma. There was a positive margin in four masses (13{\%}); 29 tumours (mean size 1.9 cm) were eligible for analysis of oncological outcomes, with a mean follow-up of 31 months. There were no tumour recurrences at the last follow-up, giving a cancer-specific survival rate of 100{\%}. CONCLUSIONS: RF-LPN with no hilar clamping simplifies the surgical technique and appears to have excellent cancer control in the intermediate term. In the few patients with a positive surgical margin, it is possible that coagulation beyond the tumour margin kills any residual microscopic tumour, minimizing or obviating the risk of tumour recurrence. Nevertheless, vigilance during tumour excision and margin identification is mandatory.",
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