CT-guided Preoperative Localization via Adjacent Microcoil Implantation Prior to Laparoscopic Partial Nephrectomy for Totally Endophytic Renal Masses Reduces Operative Time: A CaseControl Study.

Abstract

Rationale and objectives: This retrospective casecontrol study evaluated the efficacy and safety of CT-guided preoperative localization via adjacent microcoil implantation for reducing the operative time of laparoscopic partial nephrectomy (LPN) in patients with endophytic renal masses.

Methods: Data from patients who underwent LPN for completely endophytic treatment (three points for the ''E'' domain of the R.E.N.A.L. score) renal masses were collected from Beijing Friendship Hospital, Capital Medical University, between January 2020 and May 2023. Microcoils were placed adjacent to the renal masses under CT guidance prior to LPN. The head of the microcoil was pinpointed adjacent to the target endophytic renal mass, and its end tail remained outside the renal surface. Baseline characteristics and clinical, surgical, and postoperative outcomes were compared.

Results: Forty patients (microcoil localization, N = 8; standard LPN, N = 32) were included in the analysis. The median clinical tumor size was 15 mm (IQR: 10-22). In all patients in the microcoil localization group, the microcoil was successfully visualized laparoscopically by the surgeons. The microcoil localization technique demonstrated a significantly shorter operative time under general anesthesia (150 vs. 195 min, P = 0.012) and a nonsignificant trend towards a shorter hospital stay (8.6 vs. 11.7 days, P = 0.079). The microcoil localization technique showed a nonsignificant trend toward a reduced total operative time (189 vs. 195 min, P = 0.012). No significant differences were observed in histopathological findings, surgical approach, postoperative eGFR levels, eGFRs, or complication rates were observed between the groups.

Conclusion: This study suggested the use of a local microcoil on the surface of the kidney to locate the tumor accurately, which offers a more patient-centered surgical approach and can serve as a standard approach for treating totally endophytic renal masses that require localization.