Laparoscopic aspirator bracket: A new instrument facilitating the aspiration and exposure of operative field simultaneously in laparoscopic nephron-sparing surgery

Abstract Background Laparoscopic nephron-sparing surgery (NSS) is the standard of care for small renal masses whenever feasible. This study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic NSS by a simple enucleation technique. Methods Between July 2017 and July 2019, we performed 54 laparoscopic NSS due to renal tumour using an SE technique by either LAB (n = 26) or laparoscopic aspirator (LA, n = 28) in 3 independent medical centres by 6 experienced surgeons. The novel aspirator could aspirate liquid and expose the operative field simultaneously. The details of operative technique are provided in the accompanying video. General characteristics and perioperative data of all patients were collected and retrospectively. Patients were followed up for 12 months after laparoscopic renal tumor simple enucleation (SE) operation. Renal function outcomes and perioperative complications were assessed. Results All 54 patients were successfully operated without conversion to open surgery. The use of the LAB in laparoscopic renal tumor SE operation can shorten the warm ischemia time ([WIT], LAB 12.92 ± 8.38 min vs. LA 17.89 ± 6.73 min) and increase the zero ischemia (ZI) rate (LAB 23.08% vs. LA 3.57%). In the one-year follow-up, the LAB group showed quicker renal function recovery (ipsilateral renal function 3 months after the surgery, LAB 41.67 ± 10.11% vs. LA 36.75 ± 10.30%). The limitations of this study were limited number of patients and retrospective attribute. Conclusion The new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten WIT and improve the postoperative renal function recovery.