2023 Volume 36 Issue 2 Pages 249-254
Purpose : To evaluate trifecta outcomes in off-clamp, sutureless, laparoscopic partial nephrectomy (LPN) using soft coagulation.
Materials and Methods : We evaluated the perioperative oncological and functional outcomes of 46 patients with a cT1 renal mass undergoing LPN. All procedures were attempted with enucleoresection using soft coagulation without vascular clamping or renorrhaphy. Trifecta achievement was defined as the following combination : minimal renal functional decrease, negative surgical margins, and no postoperative urological complications. We defined a preserved renal function as eGFR preservation ≧90％ after surgery.
Results : The median tumor size was 27 mm and preoperative clinical T stage was T1a/T1b in 42/4 patients. The R.E.N.A.L. nephrometry scores were low in 29 (4-6), moderate (7-9) in 15, and high (10-12) in two, respectively. No patient required vascular clamping or conversion to open or radical nephrectomy. The median estimated blood loss was 83 mL. Overall postoperative complications were observed in two (4.3％) patients. One patient had a positive surgical margin. The median postoperative eGFR decline was 1.5％, and the renal function was preserved in 41 (89％) patients. In total, the trifecta accomplishment rate was 83％.
Conclusion : Trifecta was achieved in more than 80％ of patients undergoing off-clamp, sutureless, LPN.
