Laparoscopic partial nephrectomy for selected central tumours: Omitting the bolster

OBJECTIVE: To describe an alternative technique of laparoscopic partial nephrectomy (LPN) for selected central tumours that avoids bolstered renorrhaphy, LPN for such tumours often requires a substantial resection, including collecting-system entry, and renal reconstruction typically requires oversuturing the tumour defect and bolstered renorrhaphy, increasing the warm ischaemia time. PATIENTS AND METHODS: After excising the tumour, the tumour bed defect in 23 selected patients was closed with intraparenchymal sutures and biological gelatine matrix-thrombin sealant, with no bolstered renorrhaphy. Data on outcomes during and after surgery were collected prospectively. RESULTS: The median (range) tumour size was 2.5 (1.7-5) cm, the warm ischaemia time 20 (9-44) min, the estimated blood loss 150 (50-1000) mL, and 80 (45-95)% of the kidney was spared. Complications occurred in four patients (17%), i.e. one each with a postoperative haemorrhage with a lateral tumour, requiring surgical re-exploration, a urine leak that resolved spontaneously, postoperative anaemia, and atrial fibrillation. CONCLUSIONS: In properly selected patients with a central tumour extending to the collecting system, the LPN defect can be reconstructed safely with a running intraparenchymal haemostatic suture and thrombin sealant, with no bolstered renorrhaphy. The operation is simplified and the warm ischaemia time significantly less. A lateral tumour, wherein the resultant LPN defect faces away from the surgeon, precluding uniform contact of sealant with the entire tumour bed, has the potential for postoperative haemorrhage, and is a contraindication for this technique.