Precautions for laparoscopic kidney preservation surgery

  With the widespread use of modern imaging technology and routine physical examinations, the number of incidental renal tumors (less than 4 cm) detected at an early stage has increased, and laparoscopic partial nephrectomy is gradually being performed in medical centers where it is available, and laparoscopic partial nephrectomy with preservation of the renal unit has gradually developed into a more mature technique.  Laparoscopic partial nephrectomy with preservation of the renal unit can be accomplished through both the abdominal and retroperitoneal routes. In addition to the respective characteristics of the two routes in a general sense, we believe that: 1. Tumors in the ventral and lower pole of the kidney are more easily accomplished through the ventral route, and the retroperitoneal route is more suitable for tumors in the upper pole and dorsal side.  2. CT films should be read carefully before surgery, and CT vascular digital reconstruction should be performed as much as possible if possible to understand the renal artery course and branch blood supply, so as to guide the renal artery freeing during surgery and avoid incomplete blockage and lack of clear surgical field, which affects the complete resection of tumor.  3. For most renal parenchyma incision depths greater than 2 cm, at least two layers of sutures should be performed to avoid incomplete hemostasis and excessive tension and to reduce the risk of postoperative bleeding and urinary leakage. In some cases, the tumor invades the renal parenchyma too deeply or the resection process cuts through the renal collecting system, which should be sutured separately to stop bleeding or repair to avoid postoperative leakage or secondary bleeding. The outermost suture can be a continuous suture assisted by Hemolock clip to simplify the operation and save time.  4. If conservative treatment of secondary bleeding after surgery is ineffective, most of them can be stopped by selective renal artery embolization.  5. Strenuous activity and constipation should be avoided postoperatively to prevent bleeding.