Retroperitoneoscopic Partial Nephrectomy for Moderately Complex Ventral Hilar Tumors: Surgical Technique and Trifecta Outcomes from a Single Institution in China

Objectives: T1 ventral renal hilar tumors (VRHTs) represent a very special type of tumor, for which laparoscopic partial nephrectomy (LPN) by the retroperitoneal approach is challenging. In this study, we report our surgical technique and Trifecta results.Methods: Renal rotation technique has been established for retroperitoneal laparoscopic partial nephrectomy (RLPN) for VRHTs in our institution. Trifecta was used as a composite outcome measure for assessing quality of PLPN using this technique. A retrospective analysis of RLPN cases in 12 patients with VRHTs was performed.Results: Mean tumor size was 3.4 cm and median R.E.N.A.L. score was 8 (range 7-9). Mean warm ischemia time was 23.1 minutes, suture time 28.1 minutes, estimated blood loss 139.2mL, operation time 122.8 minutes, and median hospital staywas 4 days. Three patients (25.0%) had Clavien-Dindo grade I-II complications. Seven patients (58.3%) achieved Trifecta. Postoperative pathological examination showed renal cell carcinoma in all cases with negative surgical margin. A median follow-up of 7 months revealed no local recurrence or distant metastases.Conclusions: Our Trifecta outcomes demonstrate that RLPN with renal rotation technique is feasible, safe, and effective for moderately complex VRHTs. The short-term functional and oncologic outcomes are promising; however, long-term follow-up is needed.

目的：T1期肾门腹侧肿瘤（VRHTs）是一种非常特殊的肿瘤类型，经腹膜后途径行腹腔镜肾部分切除术（LPN）具有挑战性。在本研究中，我们报告我们的手术技术以及“三联结局”结果。 方法：我们机构已建立了用于肾门腹侧肿瘤（VRHTs）腹膜后腹腔镜肾部分切除术（RLPN）的肾脏旋转技术。使用“三联结局”作为综合结局指标来评估应用该技术的腹腔镜肾部分切除术（PLPN）的质量。对12例肾门腹侧肿瘤（VRHTs）患者的腹膜后腹腔镜肾部分切除术（RLPN）病例进行回顾性分析。 结果：平均肿瘤大小为3.4厘米，R.E.N.A.L.评分中位数为8分（范围7 - 9分）。平均热缺血时间为23.1分钟，缝合时间为28.1分钟，估计失血量为139.2毫升，手术时间为122.8分钟，住院时间中位数为4天。3例患者（25.0%）出现Clavien - Dindo I - II级并发症。7例患者（58.3%）达到“三联结局”。术后病理检查显示所有病例均为肾细胞癌，手术切缘阴性。中位随访7个月，未发现局部复发或远处转移。 结论：我们的“三联结局”结果表明，采用肾脏旋转技术的腹膜后腹腔镜肾部分切除术（RLPN）对于中度复杂的肾门腹侧肿瘤（VRHTs）是可行、安全且有效的。短期的功能和肿瘤学结果是有前景的；然而，需要长期随访。