Laparoscopic Partial Nephrectomy - (LPN) Case Demonstration 2010.mpg

The gold standard treatment for small renal masses is a partial nephrectomy. This means that the goal should be to remove the kidney mass only with a small margin of tissue and leave the remaining portion of the kidney to help maximize the patient's renal function. A partial nephrectomy can be performed through a skin incision (open technique) or via small trocars (laparoscopy or robotic-assisted). The benefits of the latter is the improved cosmesis, less blood loss, shorter hospital stay and quicker recovery. Surgeon experience and level of expertise, as well as the location of the kidney tumor play a role in decision making. The following live case presentation will highlight the several steps of a laparoscopic partial nephrectomy (LPN). We highlight the specific details of tumor identification, excision with scissors and repair of the defect. All such aspects need to be ideally completed within 20-30 minutes to minimize the damage related to no blood flow in the kideny. More specifically, during LPN, the surgeon must clamp the blood supply to the entire kidney to ensure minimal blood loss. We highlight the use of laparoscopic bulldog clamps for complete hilar control (arterial and venous), deep layer renorraphy with the self-achoring, barbed VLoc suture and the superficial layer kidney closure with the sliding Weck-clip renorraphy.

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