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‘Two-Step’ Partial Nephrectomy: A Description of a Novel Technique and Assessment of an Initial Series
Journal article   Open access   Peer reviewed

‘Two-Step’ Partial Nephrectomy: A Description of a Novel Technique and Assessment of an Initial Series

K Siddiqi, S Shah, B Boyd, J Miller and J Brown
Current urology, Vol.4(3), pp.156-161
09/2010
DOI: 10.1159/000253443
url
https://doi.org/10.1159/000253443View
Published (Version of record) Open Access

Abstract

Background/Aims: Partial nephrectomy (PN) is more challenging in solitary kidneys and when tumors are interpolar, hilar, endophytic, deeply penetrating, large or irregular. We propose an alternative ‘two-step’ technique for assuring negative margins and consistent parenchymal preservation in these situations. Methods: We retrospectively reviewed 6 open and 3 hand-assisted laparoscopic PNs performed between November 2001 and August 2005. Tumor enucleation was followed by resection of an approximate 1 cm thick rim (wafer) of tissue from the tumor bed. Clinical variables and intraoperative data were reviewed. Results: Mean patient age was 57.4 years (49–69 years). Mean enucleated tumor diameter was 3.7 cm (1–9 cm). Three of nine (33%) enucleated tumors had positive margins. The wafer surface adjacent to the enucleated specimen was positive in all three, and the average depth of tumor invasion into the wafer was 5.4 mm (3.2–8 mm). The wafer surface adjacent to normal parenchyma was never positive. The average wafer depth removed was 1.19 cm. Average vessel clamp and total operative times were 24.5 and 295 minutes, respectively. Mean estimated blood loss was 372 ml. Mean preoperative and postoperative creatinine was 1.05 and 1.53 mg/dl, respectively. No patient has developed a local or distant recurrence (mean follow-up 27.1 months). Conclusions: A ‘two-step’ PN appears to be an effective surgical margin and renal parenchymal preserving technique. It is important to remove a 1 cm thick wafer as 1/3 of cases demonstrated tumor infiltration to a depth of 3–8 mm. This technique minimizes the need to address a positive frozen section margin.
 Surgical Technique

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