Artery-Only Occlusion May Provide Superior Renal Preservation During Laparoscopic Partial Nephrectomy

Gong, Edward M.; Zorn, Kevin C.; Orvieto, Marcelo A.; Lucioni, Alvaro; Msezane, Lambda P.; Shalhav, Arieh L.

doi:10.1016/j.urology.2008.05.020

Cited by 71 publications

(37 citation statements)

References 8 publications

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“…Thus, methods to reduce the clamp time rather than to completely eliminate it, such as the use of ‘on-demand' clamping and/or early unclamping, must also be considered [23,24]. Other strategies to minimise renal ischaemia such as selective arterial clamping [25,26,27], clamping the renal artery and not the renal vein, which has been suggested to allow for limited oxygenation via venous backflow [28], and utilising cold ischaemia have also been described (although the latter is challenging during minimal access surgery) [29,30]. …”

Section: Discussionmentioning

confidence: 99%

Comparison of Off-Clamp Partial Nephrectomy and On-Clamp Partial Nephrectomy: A Systematic Review and Meta-Analysis

Trehan¹

2014

Urol Int

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Objective: To compare peri- and postoperative variables, surgical complications, oncological outcomes and renal outcomes of off-clamp partial nephrectomy (PN) and on-clamp PN. Methods: A systematic search of the electronic databases, including MEDLINE, Embase and Cochrane Library, was performed. The pooled estimates of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, positive surgical margins and eGFR were calculated. Results: 14 studies were included. There was no significant difference between off-clamp PN and on-clamp PN in terms of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, and positive surgical margins. However, a non-statistically significant trend towards increased blood loss (p = 0.12) and transfusion rates (p = 0.07) in those undergoing off-clamp PN was noted. Off-clamp PN was associated with a significantly lower reduction in eGFR than on-clamp PN (standardised weighted mean difference 0.27, 95% CI 0.14, 0.40, p < 0.0001). Conclusions: Off-clamp PN may be associated with improved long-term renal outcomes when compared to on-clamp PN with no difference in in peri- and postoperative variables, surgical complications and oncological outcomes. However, the meta-analysis was limited by the design of the underlying studies, and hence further work is necessary.

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Section: Discussionmentioning

confidence: 99%

Comparison of Off-Clamp Partial Nephrectomy and On-Clamp Partial Nephrectomy: A Systematic Review and Meta-Analysis

Trehan¹

2014

Urol Int

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“…Indeed, it has been reported that clamping the artery only, as opposed to controlling both the artery and vein, resulted in increased blood loss while providing better renal function during LPN. 22 Second, more complex and deeper tumors were in the cross-clamp group. More recently, we have started cross-clamping both the renal artery and renal vein.…”

Section: Koo Et Almentioning

confidence: 92%

Renal Hilar Control During Laparoscopic Partial Nephrectomy: To Clamp or Not to Clamp

Koo

Lee²,

Kim

2010

Journal of Endourology

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“…This would save about 30 minutes of intraoperative time for dissecting the vessels, and cushion the renal vessels from the vascular clamp 8 . However, some studies have shown that renal function is better preserved when only the renal artery is clamped for a partial nephrectomy [9][10][11] . Recently, a study in rats submitted to 60 minutes of kidney warm ischemia demonstrated that arterial only clamping did not impair the renal parenchyma, different from arteriovenous clamping that decreased the glomerular number 12 .…”

Section: Introductionmentioning

confidence: 99%

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

et al. 2016

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PURPOSE:To evaluate the glomerular loss after arteriovenous or arterial warm ischemia in a swine model. METHODS:Twenty four pigs were divided into Group Sham (submitted to all surgical steps except the renal ischemia), Group AV (submitted to 30 minutes of warm ischemia by arteriovenous clamping of left kidney vessels), and Group A (submitted to 30 minutes of ischemia by arterial clamping). Right kidneys were used as controls. Weigh, volume, cortical volume, glomerular volumetric density (Vv[Glom]), volume-weighted glomerular volume (VWGV), and the total number of glomeruli were measured for each organ. RESULTS:Group AV showed a 24.5% reduction in its left kidney Vv[Glom] and a 25.4% reduction in the VWGV, when compared to the right kidney. Reductions were also observed when compared to kidneys of sham group. There was a reduction of 19.2% in the total number of glomeruli in AV kidneys. No difference was observed in any parameters analyzed on the left kidneys from group A. CONCLUSIONS:Renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage, but arteriovenous clamping caused significant glomerular loss in a swine model. Clamping only the renal artery should be considered to minimize renal injury after partial nephrectomies.

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Artery-Only Occlusion May Provide Superior Renal Preservation During Laparoscopic Partial Nephrectomy

Cited by 71 publications

References 8 publications

Comparison of Off-Clamp Partial Nephrectomy and On-Clamp Partial Nephrectomy: A Systematic Review and Meta-Analysis

Comparison of Off-Clamp Partial Nephrectomy and On-Clamp Partial Nephrectomy: A Systematic Review and Meta-Analysis

Renal Hilar Control During Laparoscopic Partial Nephrectomy: To Clamp or Not to Clamp

Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model

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