Laparoscopic nephron-sparing surgery in the presence of renal artery disease.

Introduction: To describe the technical considerations of laparoscopic nephron-sparing surgery in 3 complicated cases involving kidneys with renal arterial disease.

Technical Considerations: Three candidates for nephron-sparing surgery each had a renal mass, measuring 5.0, 3.5, and 2.5 cm, respectively. The renal arterial pathologic features in the tumor-bearing kidney included renal artery stenosis treated by percutaneous angioplasty and stenting in 1 patient and upper pole intrarenal aneurysm in 1 patient; the final patient had previously undergone aortorenal bypass grafting. The preoperative serum creatinine in the 3 patients was 2.1, 1.0, and 2.5 mg/dL, respectively. Two patients had a solitary functioning kidney. Laparoscopic partial nephrectomy with hilar clamping was performed in 2 patients and laparoscopic renal cryoablation in 1 patient. Laparoscopic Doppler ultrasonography was used in each case. The total operative time for the 3 patients was 2.3, 4.0, and 2.8 hours, respectively. The warm ischemia time in the first 2 cases was 28 and 39 minutes, respectively. The blood loss was 50, 400, and 100 mL. Pathologic examination revealed renal cell carcinoma in 2 cases and a calcified aneurysm in 1 case. The hospital stay was 7, 4, and 2 days. The postoperative serum creatinine level was 2.3, 1.4, and 2.5 mg/dL.

Conclusions: Laparoscopic nephron-sparing surgery is a feasible alternative to open partial nephrectomy and can be successfully applied to select patients with a pathologic renal artery.