New technique for nephron-sparing surgery in polar tumours. A modification of the Kim technique. / Nueva técnica para cirugía conservadora de nefronas en tumores polares. Una modificación de la técnica de Kim.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumours and those larger than 4cm based on the principle of the technique described by Kim in 1964. METHOD: The technique performs a continuous circular suture on the base of the tumour, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique. RESULTS: The patients' mean age was 56 years (30-69). The R.E.N.A.L. scores were as follows 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75-140), and the mean estimated blood loss was 120mL (50-300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2-6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was -0.71mL/min/m2. The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas. CONCLUSION: The proposed technique showed acceptable results, with a low rate of complications in the patient group.