Off-clamp Laparoscopic Partial Nephrectomy: preoperative imaging and tumor enucleation
The video shows two patients underwent off-clamp laparoscopic tumor enucleation after a meticulous analysis of preoperative imagining. The first case is a 57 year old woman diagnosed with 3.4 cm right renal tumor, normal renal function, PADUA score 6, loacated on segment 9, 70% exophytic, 15 mm distant from collecting system, absence of feeding arteries and integrity of the pseudocapsule surrounding the tumor. The second case is a 50 year old gentleman with stage 3 CKD diagnosed with cm right oncocytoma involving segments 3 and 1, 30% exophytic, 3 mm distant from the collecting system, no feeding arteries identified and a complete pseudocapsule surrounding the tumor.
In the first case operative time was 115 minutes, estimated blood loss 250 ml and the patient was discharged on postoperative day 3. Final pathology showed pT1a cromophobe RCC.
In the second case operative time was 125 minutes, estimated blood loss 300 ml and the patient was discharged on postoperative day 3. Final pathology confirmed the diagnosis of oncocytoma.
Preoperative imaging of renal masses with a standardized report and a meticulous analysis of tumor characteristics can help urologists to offer patients a tailored surgical approach to maximize renal function preservation without undermining oncologic principles and safety.