The application of microwave ablation assisted clamp-lees suture-less technique in renal hilar tumor enucleation
Objective To investigate the efficacy,safety of the microwave ablation assisted clamp-lees suture-less tumor enucleation technique in the management of renal hilar tumors.Methods From March 2017 to April 2020,data of 31 consecutive patients with renal hilar tumors who underwent microwave ablation assisted clamp-lees suture-less laparoscopic tumor enucleation(MACS-LTE)were retrospectively analyzed.There were 23 males and 8 females with a median age of 59(50,71)years old.The median BMI was 22.0(19.7,24.0).There were 28 cases with ECOG score 0 and 3 with score 1.The median diameter of the tumor was 3.0(2.5,4.0)cm with 16 located on the left and 15 on the right side.The median R.E.N.A.L.score was 8(7,8)and the median eGFR was 91.9(78.4,105.7)ml/(min·1.73 m2).The American Society of Anesthesiology(ASA)graded 16 cases as grade 1,13 as grade 2 and 2 as grade 3.MACS-LTE was performed for all patients.The MWA probe was introduced via the laparoscopic trocar and inserted into the tumor,which was close to the renal parenchyma.Then all tumors were enucleated along the pseudocapsule after microwave ablation was performed for 1 to 3 cycles lasting 1 to 3 minutes for each tumor with a power output of 70 W using an MTC-3C Microwave Ablation System.Results Laparoscopic MWA assisted clampless tumor enucleation was successfully performed in 30 case(29 underwent MACS-LTE and 1 required collecting system suturing).Another one converted to conventional laparoscopic partial nephrectomy because of intraoperative bleeding with 10min main renal artery clamped.No case converted to open surgery or radical nephrectomy.The median operative time was 100(80,120)min,with a median estimated blood loss of 50(50,80)ml.The median length of postoperative hospital stay was 3(3,4)d.No case required perioperative transfusion.One case with fever and urine leakage were observed postoperatively and recovered after conservative treatment.Pathologic results revealed 27 cases of clear cell carcinoma,3 of chromophobe cell carcinoma,and 1 of papillary cell carcinoma with all negative surgical margins.The median eGFR at 6 months postoperative was 90.0(79.2,100.3)ml/(min·1.73 m2).No local recurrence and distant metastasis was observed with a median follow-up of 25(16,28)months.Conclusions MACS-LTE which has the advantages of less blood loss with controllable complications could be an alternative,technique for selective renal hilar tumors.
Kidney neoplasmsHilar tumorLaparoscopyMicrowave ablationNephron sparing surgery
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