Partial Nephrectomy in Central Renal Tumors

Document Type

Article

Publication Date

5-1-2018

Publication Title

Journal of endourology / Endourological Society

Abstract

Nephron-sparing surgery, especially through a minimally invasive approach, is increasingly being performed for incidentally detected renal masses with excellent outcomes. Tumors in central location remain a surgical challenge during nephron-sparing surgery. In this chapter, we discuss the minimally invasive management of these tumors, which include complex hilar tumors and endophytic central tumors, with a focus on surgical technique. The key to management of these tumors is to maintain good preoperative hydration, achieving adequate exposure of tumor, and the use of intraoperative ultrasound to plan the resection plane. Individual vessels may be ligated as they enter close to the tumor. Careful renorrhaphy is essential, especially in hilar tumors, which have major blood vessels at the base of the tumor. Selective use of near infrared fluorescence imaging, on-demand ischemia, early unclamping, enucleoresection techniques, and intracorporeal hypothermia may help minimize, or reduce the effect of warm ischemia.

Medical Subject Headings

Hemostasis; Humans; Ischemia; Kidney Neoplasms/diagnostic imaging/surgery; Minimally Invasive Surgical Procedures/methods; Nephrectomy/methods; Nephrons/diagnostic imaging/surgery; Organ Sparing Treatments; Patient Positioning; Postoperative Period; Preoperative Period; Robotic Surgical Procedures; Ultrasonography; Video Recording; Warm Ischemia; cancer; central renal tumors; kidney cancer; nephron-sparing surgery; partial nephrectomy

PubMed ID

29774822

Volume

32

Issue

S1

First Page

63

Last Page

63

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