Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes

Purpose To evaluate the technical feasibility, safety and functional outcomes of zero ischaemia laparoscopic and robotic partial nephrectomy with controlled hypotension for renal tumours larger than 4 cm. Methods We evaluated 121 consecutive patients with American Society of Anaesthesiologists (ASA) scores 1-2 who underwent laparoscopic (n = 70) or robotic (n = 51) partial nephrectomy with controlled hypotension with either tumour size <= 4 cm (group 1, n = 78) or tumour size > 4 cm (group 2, n = 43) performed by a single surgeon from December 2010 to December 2011. Operative data, complications, serum creatinine, estimated glomerular filtration rates and effective renal plasma flow calculated from 99mTc-mercaptoacetyltriglycine renal scintigraphy were compared. Differences between groups were evaluated by the Chi-square test and the Student's t test. Results A significant difference in mean intraoperative blood loss and postoperative complications was found between the two groups: 168 ml (range: 10-600 ml in group 1) and 205 ml (range: 90-700 ml in group 2); p = 0.005, and 6.4 % versus 18.6 %; p = 0.004, respectively. The mean percentage decrease of ERPF of the operated kidney was 1.8 % in group 1 and 4.1 % in group 2. Conclusions Laparoscopic and robotic partial nephrectomy with controlled hypotension for tumours > 4 cm in ASA 1-2 patients was feasible with significant higher intraoperative blood loss and postoperative complications compared to smaller renal masses. The benefits of avoiding hilar clamping to preserve kidney function seem excellent.