To evaluate a new hybrid technique which we defined mini-laparoendoscopic single-site partial nephrectomy (MILESS-PN) for renal masses presenting an intermediate PADUA score.
Forty consecutive cases of MILESS-PN performed between April 2013 and November 2015 were included in this study. MILESS consisted in the simultaneous use of two 3 mm pararectal trocars and an umbilical SILS trocar; the sequence of steps of MILESS-PN was comparable to standard laparoscopic partial nephrectomy. Demographic data, main perioperative and oncologic outcome parameters were gathered and analyzed.
Median operative time was 134.6 (IQR 110-180) min with a median WIT of 12.1 (IQR 9.5-15.5) min. Postoperatively, 4 early complications were recorded and median hospital stay resulted to be 4.2 (IQR 3.5-6) days. Median renal tumor size was 3.6 (IQR 2.4-5.3) cm with a median PADUA score of 8.3 (IQR 8-9). The definitive pathologic results revealed a RCC in 32 cases (80%), an angiomyolipoma in 3 cases (7.5%) and an oncocytoma in 5 cases (12.5%). All tumors were removed with negative surgical margins and, at the median follow-up of 34.5 (IQR 24-48) months, all patients were alive without evidence of tumor recurrence or port-site metastasis. A statistically significant decrease of eGFR was observed postoperatively (post- vs preoperative median eGFR: 87.6 (IQR 70.4-101.8) and 104.7 (IQR 82.7-123.3), p<0.0001) and at 6 months (6-mo vs preoperative eGFR 93.6 (IQR 79.1-110.2) and 104.7 (IQR 82.7-123.3), p< 0.0001).
MILESS-PN for renal tumors with intermediate PADUA score in well-selected patients is not associated with increased risks for the patients, presenting excellent oncologic and functional results at mid-term follow-up. MILESS could represent a valid alternative to LESS or minilaparoscopy because of its higher surgical reproducibility.
Urology. 2017 Oct 09 [Epub ahead of print]
Christopher Springer, Felix Kawan, Roberto La Rocca, Nasreldin Mohammed, Paolo Fornara, Vincenzo Mirone, Francesco Greco
Department of Urology and renal transplantation, Martin-Luther University, Halle/Saale, Germany., Department of Urology, Federico II University, Naples, Italy., Department of Urology and renal transplantation, Martin-Luther University, Halle/Saale, Germany; Department of Urology, Federico II University, Naples, Italy. Electronic address: .