Bolsterless laparoscopic partial nephrectomy: A simplification of the technique

Background and Purpose: Laparoscopic partial nephrectomy is a demanding procedure. To popularize the procedure, simplifying the technique is of great concern for most laparoscopic urologists. Our objective was to evaluate the results of laparoscopic partial nephrectomy (LPN) when eliminating bolster in repair of the tumor bed. Patients and Methods: Thirty-three patients with single sporadic renal masses who underwent LPN are included in this study. After tumor excision, both parenchymal tissue and collecting system (if violated) were closed with a single row of polyglactin 2/0 stitches in running fashion. No bolster was applied in the renal defect, even in broad tumor beds. To avoid time-consuming knot tying, the sutures were buttressed by the use of Hem-o-Lok clips. No ureteral stenting was performed after repair. Data on perioperative and early postoperative outcomes were collected prospectively. Results: Mean tumor size was 4.06 ± 1.13 cm (range 1.80-6 cm), with 15 tumors larger than 4 cm in greatest diameter. Blood loss was minimal. Mean ischemia time was 25.8 ± 6.9 minutes (range 14-39 min). Urine leakage occurred in one (3.0%) patient and was managed conservatively. Three (9.0%) patients received blood transfusion. All of the procedures were completed laparoscopically without the need for open conversion or postoperative surgical intervention. Conclusion: LPN could be accomplished safely without the use of bolster. Such an approach could help simplify the procedure and consequently popularize it among urologists.