Single-setting bilateral hand-assisted laparoscopic partial nephrectomy

Purpose: To assess the feasibility and safety of single-setting bilateral hand-assisted laparoscopic partial nephrectomy. Materials and Methods: Between August 2003 and June 2004, we performed single-setting bilateral laparoscopic partial nephrectomies on three patients. A hand-assisted approach was used, employing the same hand-assistance incision for both sides. Renal hilar clamping was not required, as the depth of penetration of all six tumors was only 0 to 4 mm (mean, 1.8 mm). The tumor diameters ranged from 1.8 to 3.8 cm (mean, 2.4 cm). Results: All operations were performed successfully, with no conversion to open surgery. Excision was performed with bipolar forceps, and final hemostasis was obtained with an argon beam coagulator (Valleylab, Boulder, CO) and Floseal (Baxter, Deerfield, IL), without suturing. The mean estimated blood loss was 208 mL. The mean operative time was 246 minutes, which included repositioning. There were no intraoperative complications, and the postoperative course was uneventful in all patients except for a hospital stay of 5 days in one patient owing to transient ileus. Pathology revealed a benign lesion on one side and renal cell carcinoma on the other side in two patients, and bilateral leiomyomas in one patient. All margins of resection were negative, and neither of the two patients with cancer has had recurrence at a mean follow-up of 51 months. Among all three patients, the mean preoperative serum creatinine was 0.9 mg/dL, and the average level at a mean of 35 months postoperatively was 1.0 mg/dL. Conclusion: Single-setting bilateral hand-assisted laparoscopic partial nephrectomies can be safely and effectively performed on patients with bilateral small exophytic kidney tumors. We do not recommend this technique if both kidneys require temporary hilar occlusion, but it can be considered if only one kidney requires hilar occlusion.