Abstract: Objective To investigate the efficacy and safety of different surgical treatment of retroperitoneal laparoscopic partial nephrectomy for patients with localized renal cell carcinoma.
Methods 127 patients with tumor size ＜4cm underwent RLPN from February 2006 to December 2012 in our hospital. According to the course of the new surgical techniques adopted， they were divided into 4 groups：conventional group（n=44）， simple enucleation group（n=35）， knotfree suture group（n=39）and selective artery clamping group（n=9）. The data of operative time， renal artery clamping time， blood loss during operation， postoperative hospital stay， intraoperative transfusion rate and the incidence of urinary leakage postoperation were collected， and those data of the former three groups were statistical analyzed.
Results The mean time of renal artery clamping in the former three groups was（32.07±5.59）min，（30.20±5.84）min，（27.31±6.17）min，respectively. The mean operative time were（109.68±20.07）min，（106.20±16.32）min，（97.00±17.65）min，respectively. The mean blood loss during operation was（106.93±72.26）ml，（80.26±49.57）ml，（54.23±36.32）ml，respectively. The mean time of postoperative hospital stay was（7.82±1.42）d，（6.31±1.69）d，（5.97±1.51）d， respectively. There were statistically differences between the three groups on the time of renal artery clamping， the operative time， the blood loss and the time of postoperative hospital stay（P＜005）. The rate of transfusion during operation was 2.3％（1／44）， 0（0／35）， 0（0／39）， respectively. The incidence of urinary leakage after operation was 0（0／44）， 2.9％（1／35）， 2.6％（1／39）. The above clinical parameters had no significant differences among the three groups（P＞0.05）. All the patients were followed up for 1460 months, and no recurrence and metastasis was found.
ConclusionFor small renal cell cancer, the techniques of simple enucleation and knot free suture can significantly reduce renal artery clamping time and blood loss during operation. The techniques of selective artery clamping will prolong the operation time and almost have no warm ischemia time and it can deserve further research.