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Renal Transposition During Minimally Invasive Partial Nephrectomy: A Safe Technique for Excision of Upper Pole Tumors
Joshua R. Kaplan, MD, Peter Chang, MD, Andrew G. Percy, MA, Andrew A. Wagner, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

Background:
Minimally invasive partial nephrectomy (MIPN) for upper pole masses, particularly those located posteriorly, is challenging due to difficult visualization during tumor resection and renorrhaphy. The existing literature suggests that the open approach may be safer than the minimally invasive approach for upper pole tumors.
Methods:
We describe perioperative and short-term outcomes for 16 patients with upper pole renal masses who underwent MIPN (14 robotic and 2 laparoscopic) with renal transposition from October 2009 to March 2012 at an academic institution. Median follow-up was 15 months. In MIPN, the kidney is rotated anterior-posteriorly around its hilar axis so that upper pole posterior tumors are in the lower pole anterior position. We prospectively measured patient demographics, operative time, warm ischemic time, blood loss, and perioperative complications as well as pathologic and postoperative outcomes.
Results:
Mean age at treatment was 49.9 years and mean tumor size was 2.9 cm. Mean operative time was 242.6 minutes with a mean warm ischemic time of 14.7 minutes. Mean estimated blood loss was 440 mL. No patient required an intraoperative or postoperative blood transfusion. Five patients (31%) had a postoperative complication (four Clavien grade I, one Clavien grade II). There were no positive surgical margins or tumor recurrences. With a median follow-up of 15 months, no patients had a delayed complication. Mean postoperative eGFR change within 3 months was -9.4%.
Conclusions:
Our study demonstrates a technique to more easily access and excise difficult-to-reach upper pole tumors in patients undergoing transperitoneal MIPN. Our results suggest that an experienced minimally invasive kidney surgery team can safely employ this technique to facilitate excision of upper pole tumors.


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