E 2 3 5What ' s known on the subject? and What does the study add? Off-clamp laparoscopic partial nephrectomy (LPN) is thought to preserve renal function by limiting warm ischaemia time (WIT) and consequently reperfusion injury. To date, studies using the off-clamp technique represent a heterogeneous group, with limited follow-up showing feasibility and safety in a restricted number of cases.We report the largest experience of off-clamp vs on-clamp LPN with perioperative outcomes and intermediate follow-up of renal functional outcomes with stratifi cation by WIT.
OBJECTIVE• To evaluate perioperative and 6-month renal functional outcomes of patients undergoing off-clamp vs complete hilar control laparoscopic partial nephrectomy (LPN).
PATIENTS AND METHODS• A retrospective review of 489 patients undergoing LPN was completed.• Preoperative imaging assessed tumour characteristics.• Patient demographics, perioperative parameters, and postoperative outcomes were documented.• Multivariable regression analysis was used to assess factors contributing to changes in postoperative renal function between off-clamp and clamped LPN.
RESULTS• In all, 289 LPNs were performed on-clamp and 150 were performed off-clamp.• Tumours in the on-clamp group were larger than those in the off-clamp group • Univariable analysis comparing off-clamp to on-clamp cohorts showed that estimated glomerular fi ltration rate (eGFR) was better preserved in the off-clamp cohort at 6 months ( − 5.8% vs -11.4%, P = 0.046). Multivariable analysis of the groups showed that estimate blood loss ( P = 0.015) and warm ischaemia time (WIT, P < 0.001) were the only signifi cant predictors of decreased eGFR in the postoperative period.• Difference in eGFR at 6 months was not signifi cant when WIT was limited to 30 min. The complication rate was greater in the clamped cohort (10% vs 20%, P = 0.012).• There was no difference in transfusion rate or positive margin status.
CONCLUSIONS• LPN without hilar clamping is feasible, safe and associated with less renal injury as assessed by postoperative GFR in select patients.• With experience, it can be applied to complex renal lesions.
KEYWORDSrenal cell carcinoma , renal ischemia , laparoscopic partial nephrectomy , ischaemia-reperfusion injury
We report here a reliable green method for the synthesis of palladium nanoparticles supported on copper oxide as a highly active and efficient catalyst for Suzuki cross-coupling reaction. The experimental synthetic approach is based on microwave-assisted chemical reduction of an aqueous mixture of palladium and copper salt simultaneously using hydrazine hydrate as reducing agent. The catalyst was fully characterized using various techniques showing well-dispersed palladium nanoparticles. The catalytic activity and recyclability of the prepared catalyst were experimentally explored in the ligand-free Suzuki cross-coupling reaction with a diverse series of functionalized substrates. The synthesized Pd/CuO catalyst shows many advantages beside its high catalytic efficiency such as the recyclability of up to five times with negligible loss of catalytic activity, short reaction times, use of environmentally benign solvent systems, and mild reaction conditions.
The R.E.N.A.L. NS system is a comprehensive and reproducible tool that may aid surgeons in communicating tumor characteristics effectively. Interobserver correlation is high, rendering it a high fidelity assessment tool.
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