Adult Urology Superselective Embolization as First Step of Laparoscopic Partial Nephrectomy Michele Gallucci, Salvatore Guaglianone, Livio Carpanese, Rocco Papalia, Giuseppe Simone, Ester Forestiere, and Costantino Leonardo OBJECTIVES Laparoscopic partial nephrectomy is currently very hard to perform because of the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. The aim of this study was to propose a method to decrease the risk of bleeding, consisting of the superselective embolization of tumor vessels before performing the laparoscopic partial nephrectomy. METHODS Fifty patients with small, solitary, enhancing, predominantly exophytic renal tumors underwent a superselective radiographically guided embolization of tumor vessels. An average of 6 hours after embolization, the patients underwent partial laparoscopic nephrectomy, with transperito- neal access and three trocars placed, under balanced general anesthesia. The mean operative time was measured, as was the mean estimated blood loss. RESULTS The mean operative time was 90 minutes, the mean estimated blood loss was 200 mL, and the average hospital stay was 6 days. Complications were reported in only 2 patients. The final pathologic evaluation confirmed the diagnosis of renal cell carcinoma in 43 cases. The median follow-up was 11 months and, to date, the examinations have revealed no recurrences in any of the cases. CONCLUSIONS Superselective embolization is a valid option for laparoscopic partial nephrectomy. The proce- dure does not require any regional vascular control or clamping, reduces the estimated blood loss, and reduces the operative time. UROLOGY 69: 642– 646, 2007. © 2007 Elsevier Inc. T he improvement in imaging techniques has led to the increased detection of incidental small renal lesions. Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative to open partial ne- phrectomy. 1,2 Compared with open partial nephrectomy, the laparoscopic approach is associated with similar renal function outcomes, decreased postoperative narcotic use, and a shorter hospital stay. 3–5 However, LPN is currently very hard to perform owing to the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. 6,7 The aim of this study was to propose a method to decrease the risk of bleeding. This method consists of superselective embolization of the tumor vessels before performing LPN. 8 We believe this approach will also appeal to less-experienced surgeons. MATERIAL AND METHODS From August 2003 to December 2005, 50 consecutive patients underwent LPN after superselective embolization of tumor ves- sels for small, solitary, enhancing, predominantly exophytic renal tumors. The exclusion criteria were tumors centrally ex- tending into the kidney in direct contact with, or invading into, the collecting system and/or renal sinus. Of the 50 tumors, 30 were pole tumors, 12 were anterior, and 8 were posterior tumors. The mean tumor size was 3.5 cm. The clinical stage of the renal mass was T1N0M0. The mean age was 63 years (range 41 to 80). All patients were white, and 33 were men and 17 were women. The patients had been diagnosed with renal cancer by ultrasonography and/or computed tomography (CT), and all had undergone a bone scan and abdominal three-dimensional CT scan with 3 or 5-mm cuts and reconstruction. Also, preoperative renal scan- ning with radionuclides, urinalysis, and serum urea nitrogen and creatinine measurement were performed to assess the renal function. The day of hospitalization, after a blood cell count was taken, each patient underwent superselective radiographically guided embolization of the tumor vessels. The procedure was performed using a percutaneous femoral artery approach with selective catheterization of the renal artery using a hydrophilic-coated guidewire for reduced friction (Terumo Glidewire GT Hydro- philic Coated Guidewire) and a catheter equipped with a hy- drophilic-coated distal tip region for smooth passage through tortuous vasculature (Terumo Glidecath XP Hydrophilic Coated Catheter 5F). After the identification of level II order vessels using arteriographic techniques, we performed superse- lective catheterization with placement of a co-axial microcath- From the Departments of Urology and Radiology, Regina Elena Cancer Institute, Rome, Italy Reprint requests: Michele Gallucci, M.D., Department of Urology, Regina Elena Cancer Institute, Rome, Italy. E-mail: gallucci@ifo.it Submitted: May 18, 2006; accepted (with revisions): October 5, 2006 642 © 2007 Elsevier Inc. 0090-4295/07/$32.00 All Rights Reserved doi:10.1016/j.urology.2006.10.048