UroToday - The authors review their world's largest experience with laparoscopic partial nephrectomy. The overall complication rate among 507 patients was 20%. While there were no deaths in the series, among the complications 35% were of a major nature (NCI Common Toxicity Criteria III and IV). The overall incidence of postoperative hemorrhage was 5.7% and the urine leak rate was 2.4%. The authors note that when comparing their 1999-2002 experience (169 cases) to their 2003-2006 experience (338 cases), the overall complication rate decreased from 30% to 17% despite an increase in the complexity of the procedures being performed; to be sure, this represents the benefits of experience as well as the evolution of improved technology (e.g. hemostatic agents such as Floseal) and techniques. The three factors that were associated with increased complications were: prolonged warm ischemia (> 45 minutes), increased intraoperative blood loss (> 750 cc), and a solitary kidney. Lastly, patients experiencing a postoperative complication had a significantly increased hospital stay: 6.0 days vs. 2.7 days among the complication free patients.

Where does this information leave mere mortals? To be sure, this volume of cases is not available at possibly any other center in the United States. Humbly, one would have to assume that at most centers, complication rates for laparoscopic partial nephrectomy would be more in keeping with the authors' 1999-2002 experience of 30%. The question arises of whether standard laparoscopic partial nephrectomy should only be performed at major centers? Whether the answer to this question is "yes" or "no" will depend on other advances in the treatment of the small renal mass including the use of robotic surgery as well as needle ablative approaches. The latter may, in the future, make most of these concerns moot as its promise and its practice continue to expand.

Turna B, Frota R, Kamoi K, Lin YC, Aron M, Desai MM, Kaouk JH, Gill IS
J Urol. 2008 Apr;179(4):1289-94
10.1016/j.juro.2007.11.070

Reported by UroToday Medical Editor Ralph V. Clayman, MD

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