comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients

Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods [open, laparoscopic and robotic assisted] in obese [>/=30 Kg/m[2]] patients with renal tumors. Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open [n = 21], laparoscopic [n = 31] and robotic [n = 14]. The outcome variables of blood loss, length of hospital stay, and complications were assessed. Mean blood loss in the laparoscopic group [100 mls] was significantly less than open group [300 mls] and no difference between laparoscopic and robotic groups [150 mls]. We observed a shorter median hospital stay in the laparoscopic group [two days] than open group [four days] and no difference between laparoscopic and robotic groups [three days]. Three patients in the laparoscopic group had complications: Two grade II and one with grade III [based on Clavien-Dindo classification]. Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups [P > 0.05]. The mean tumor size in the laparoscopic group [2.70 cms] was significantly smaller than that of the open group [4.22 cm] [P; < 0.05], but not statistically different from that of the robotic group [2.99 cm]. Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention

Enucleation/partial nephrectomy for large mixed epithelial stromal tumor and herniating into the pelvicalyceal system

Mixed Epithelial and Stromal Tumor of the kidney is an adult renal neoplasm. It is mostly benign in nature. Typically it is composed of a mixture of epithelial and mesenchymal components. We hereby report on the feasibility of performing partial nephrectomy/enucleation for Huge Mixed Epithelial Stromal Tumor of the kidney without sacrificing the involved renal unit even in the tumors herniating into the collecting system. Two female patients on long term hormonal therapy developed large enhancing multiloculated and septated renal masses. Kidney mass size was 18.5 cms in one patient and 11.5 in the second. In one patient, the mass was herniating into the collecting system. Both patients had enucleation/partial nephrectomy. Enucleation and partial nephrectomy were successfully performed in both patients. In the patient with the mass herniating into the collecting system, the horns of the mass herniating into the collecting system were easily enucleated with repair of the collecting system and salvage of the involved renal unit. Post op pathology revealed MEST in both patients. There were no intraoperative or postoperative complications. Enucleation and partial nephrectomy for huge MEST is feasible. Mixed Epithelial Stromal Tumor herniating into the pelvicalyceal system may not warrant nephroureterectomy as previously reported