| Objective:To evaluate the safety and efficiency of clampless and sutureless retroperitoneal laparoscopic partial nephrectomy（cs-RLPN）by comparing postoperative short-term outcomes of cs-RLPN and traditional retroperitoneal laparoscopic partial nephrectomy（t-RLPN）in the treatment of the early localized renal tumor.Methods:The clinical data of 78 patients with the early localized renal tumor admitted to the urology department of the second hospital of Jilin university from January 2019 to October 2021 were analyzed retrospectively.All patients underwent retroperitoneal laparoscopic partial nephrectomy.According to the specific operation,the patients were divided into cs-RLPN group and t-RPLN group.By comparing the preoperative general conditions,tumor characteristics,intraoperative and postoperative complications,and recent postoperative renal function recovery and other related clinical data of the two groups of patients,to evaluate the clinical efficacy of clampless and sutureless retroperitoneal laparoscopic partial nephrectomy.Results:All the patients successfully completed the surgery,among which 2patients who were scheduled to receive cs-RLPN before surgery were successfully completed the operation after they changed to t-RLPN after seeking the consent of their family members due to the hemorrhage which had a great influence on their visual field during tumor resection.Two patients in the t-RLPN group were converted to open surgery during surgery,and their clinical data were not included in this study.No perirenal cooling measures were taken during the operation.The clinical data of 76 patients were finally selected,including 31 cases in cs-RLPN group and 45 cases in t-RLPN group.The preoperative general condition,tumor distribution,tumor size,R.E.N.A.L.score,operation time,the incidence of major postoperative complications,and the positive rate of surgical margins in the two groups were not statistically significant（P > 0.05）.Renal artery occlusion time in the t-RPLN group was 20.64 ± 3.31 min.The estimated intraoperative blood loss in the cs-RPLN group was more than that in the t-RLPN group 200（155,240）ml vs 150（100,220）ml（P < 0.05）.However,there was no significant difference in intraoperative blood transfusion rate and 24-hour hemoglobin change rate before and after surgery between the two groups（P > 0.05）.When we used 99 m Tc-DTPA scan to measure the GFR of the affected renal,we found that there was no significant difference in the GFR of the affected side of the renal between the two groups of patients,but compared with the t-RPLN group,patients in the cs-RLPN group had a lower rate of postoperative GFR decline in the affected side 11.36%（9.32%,14.15%）vs16.93%（11.05%,18.26%）（P < 0.001）.During the postoperative follow-up period,there was no tumor recurrence or metastasis in either group.At the same time,we found that when we used the estimated glomerular filtration rate e GFR to assess the recovery of renal function in the two groups of patients in the immediate postoperative period（3 months）,the decline rate of e GFR in the cs-RLPN group was significantly lower than that in the t-RLPN group at 1 week after surgery 8.85%（4.77%,10.48%）vs14.68%（12.87%,16.21%）（P < 0.001）,meanwhile,the decline rate of e GFR in the cs-RLPN group was still significantly lower than that in the t-RLPN group at 3 months after surgery 6.11%（2.11%,8.10%）vs 9.90%（8.68%,11.56%）（P < 0.001）.Conclusion:In our research,we found that cs-RLPN achieved the same tumor control effect as t-RLPN in the treatment of early-stage localized renal tumor diseases with size < 4 cm and R.E.N.A.L.score ≤ 6,and without increasing the incidence of postoperative complications.Moreover,it is superior to traditional surgery in the short-term postoperative recovery of renal function.Therefore,we believe that in the treatment of early localized renal tumors,especially when the tumor is not bulky and mainly present as exophytic growth,cs-RLPN can be a reasonable surgical approach. |
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