Surgical aspects of laparoscopic partial nephrectomy for neoplаsms at the renal hilum.

Introduction. Lapraroscopic partial nephrectomy (LPN) is gaining increasing popularity, and therefore it is of interest to adapt its techniques and capabilities for the treatment of patients with «complex» kidney tumors. Objective. To evaluate the effectiveness of the technical regulations for performing LPN with renal hilar tumors. Materials and methods. A single-center retrospective comparative study of the treatment outcomes of 166 patients undergoing LNP was conducted. The study group «GI» consisted of 44 patients with tumors of the renal hilum with any R.E.N.A.L. value. The comparison group «CG» consisted of 122 patients with cortical formations R.E.N.A.L. > 7. LNP was performed in «GI» patients using the proposed technical regulations. Perioperative parameters and pathological status of the tumor were assessed. Results. Conversions to open surgery or nephrectomy & positive surgical margins were not detected in all cases. The RENAL score was higher for the renal hilum group (p<0,001). There was no significant difference in the incidence of complications, blood loss, warm ischemia time, and postoperative stay (p>0,05 for all). Among all patients with left-sided lesions in the «GI», transmesenteric access was used (31,6% versus 6,8%; p=0,025). Unlike standard LRP, about a third of interventions in the «GI» were performed without nephrorrhaphy (8,2% versus 27,3% for «CG» and «GI», respectively; p=0,001). Among patients in the «GI» group, benign lesions were detected in 20,5%, and in the «CG» group – in 4,9% (p=0,002). Conclusions. Laparoscopic resection of a tumor of the renal hilum can be effectively and safely performed using the proposed technical regulations.