Laparoscopic partial nephrectomy with superselective microdissection

Abstract

The video shows three cases of laparoscopic partial nephrectomy performed with superselective microdissection.

The former is a case of a right 4cm hylar tumour with predominant endophytic growth.
With patient in extended-flank position a 5trocar-access was performed.
Once opened the peritoneum and renal capsule, the kidney was completely mobilized. We identified vascular supply of tumour and we performed selective microdissection.
Specific vascular branches supplying the tumour were clip-ligated and transected.

The second one is a case of a 2.6cm medial lower pole right renal tumor, with a main afferent artery from the aorta.
The main artery and the other small feeding artery in touch with the tumour were isolated, clipped and transacted during enucleation. A running suture was performed to complete hemostasis.

The last is a case of a 4cm left lower pole renal tumour with predominant endophytic growth.
Tumour margins were scored and dissection plane was identified with scissors.
Small feeding arteries in touch with the tumour pseudocaspule were selectively identified, clip-ligated and divided.
A sliding clip renorraphy was performed without including the posterior aspect of the parenchyma defect in order to protect the hylum.
Peritoneoum and renal capsule were closed and a drain was left in place.