"Off-clamp, non-renorrhaphy" laparoscopic partial nephrectomy with perirenal fat and Gerota's fascia reapproximation: initial experience and perioperative outcomes.

Purpose: To describe our initial experience of off-clamp, non-renorrhaphy laparoscopic partial nephrectomy (OCNR-LPN) with perirenal fat and Gerota's fascia reapproximation technique. Patients and Methods: Between August 2012 and March 2013, 24 consecutive patients underwent OCNR-LPN at our institution. After the renal mass excision, biologic hemostatics such as FLOSEAL and TISSEEL (both from Baxter Healthcare Corp., Deerfield, IL) were used, and the perirenal fat and Gerota's fascia were sutured for reapproximation. Results: All 24 consecutive patients underwent OCNR-LPN successfully. The warm ischemic time for all cases was 0 minute. Thirteen patients were noted to have a low (4-6) RENAL nephrometry score (RNS), and 11 patients had a moderate (7-9) RNS. The mean tumor size among this cohort was 2.9 (range, 1.2-6.0) cm, and the mean estimated blood loss was 243 (range, 50-700) mL. The mean hospital stay was 6.9 (range, 5-10) days. The mean percentage of postoperative estimated glomerular filtration rate change increased by 0.9%. No positive surgical margins were noted, and 2 patients with Grade III complication by the Clavien-Dindo classification were treated by endoscopic or radiological intervention. Conclusions: OCNR-LPN with the perirenal fat and Gerota's fascia reapproximation technique is feasible. Our initial experience with OCNR-LPN demonstrates encouraging results of minimal renal function loss and complications.