Fig. 3

Surgical procedures of laparoscopic partial nephrectomy. a. Exposure of retroperitoneal tissue: Release the fascial tissue of the colon and abdominal cavity with an ultrasound scalpel, turn the hepatic or splenic flexure of the colon to the opposite side, expose the retroperitoneal tissue (A1-2). b. Separate the renal artery and vein: Separate the plane of the renal vein along the retroperitoneal and Gerota fascial space, free the renal vein, and find the renal artery behind the renal vein, free the renal artery (B1-2). c. Location of the tumor: Cut the perirenal fat capsule in the middle of the kidney to find the location of the tumor, free the adipose tissue around the tumor, expose the tumor at the boundary of normal kidney tissue, preserve the adipose tissue above the tumor (C), d. Resect the tumor: Block the main renal artery with vascular clips, and resect the tumor with scissors and aspirator 1 cm outside the edge of the tumor, together with part of normal kidney tissue (D). e. Hemostasis and suture: Initial hemostasis using bipolar electrocoagulation on the wound surface. The inner layer was sutured with 3-0 barbed suture, and the renal wound was sutured with 2-0 barbed coil layer, and the suture was fixed intermittently with Hem-o-lock (E). f. Restore blood flow and observe blood supply: Loosen the renal artery blocking clamp, observe whether the blood supply, color, elasticity of renal tissue are normal, whether there are obvious bleeding foci, and explore whether the ureter is normal, whether the urine color is normal (F). Protein glue can be used to plug the wound to assist hemostasis if necessary, and the perirenal fat capsule can be re-sutured