Comparison of Total, Selective, and Nonarterial Clamping Techniques During Laparoscopic and Robot-Assisted Partial Nephrectomy

Martin, George L.; Warner, Jonathan N.; Nateras, Rafael Nunez; Andrews, Paul; Humphreys, Mitchell R.; Castle, Erik P.

doi:10.1089/end.2011.0304

Cited by 46 publications

(48 citation statements)

References 20 publications

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“…Pooled data from six studies [8,17,18,19,20,21] which reported the operative time for PN showed that the operative times of regional and global ischemia were not significantly different (WMD = 20.35 min, 95% CI: -0.28-40.97, p = 0.05) (fig. 2a).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [8,17,18,19,20,21] reported margin status and one case [21] in global ischemia had a positive margin, while no cases in regional ischemia showed a positive margin (1 of 201 global ischemia cases vs. 0 of 162 regional ischemia cases).…”

Section: Resultsmentioning

confidence: 99%

“…Pooled data from five studies [8,17,18,19,21] were used to assess complication and blood transfusion rates. Rates of complication of regional and global ischemia (OR = 1.16, 95% CI: 0.63-2.15, p = 0.63) (fig.…”

Section: Resultsmentioning

confidence: 99%

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Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Wang¹,

Zhang³

et al. 2014

Urol Int

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Objective: To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN). Materials and Methods: A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed. Results: Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins. Conclusions: Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Wang¹,

Zhang³

et al. 2014

Urol Int

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“…Reducing renal IR injury in NSS remains a challenge. Renal IR injury in NSS can be reduced by short ischemia time and by regional or zero ischemia techniques, but these methods require great skill to perform, making widespread implementation difficult [5][6][7] . Thus, there is a need for a simple technique that easier to be promoted.…”

Section: ■ Introductionmentioning

confidence: 99%

Low-energy shock wave preconditioning reduces renal ischemic reperfusion injury caused by renal artery occlusion

Xue

Chen

et al. 2017

Acta Cir. Bras.

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. Acquisition, analysis and interpretation of data; statistical analysis. AbstractPurpose: To evaluate whether low energy shock wave preconditioning could reduce renal ischemic reperfusion injury caused by renal artery occlusion. Methods: The right kidneys of 64 male Sprague Dawley rats were removed to establish an isolated kidney model. The rats were then divided into four treatment groups: Group 1 was the sham treatment group; Group 2, received only low-energy (12 kv, 1 Hz, 200 times) shock wave preconditioning; Group 3 received the same low-energy shock wave preconditioning as Group 2, and then the left renal artery was occluded for 45 minutes; and Group 4 had the left renal artery occluded for 45 minutes. At 24 hours and one-week time points after reperfusion, serum inducible nitric oxide synthase (iNOS), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), creatinine (Cr), and cystatin C (Cys C) levels were measured, malondialdehyde (MDA) in kidney tissue was detected, and changes in nephric morphology were evaluated by light and electron microscopy. Results: Twenty-four hours after reperfusion, serum iNOS, NGAL, Cr, Cys C, and MDA levels in Group 3 were significantly lower than those in Group 4; light and electron microscopy showed that the renal tissue injury in Group 3 was significantly lighter than that in Group 4. One week after reperfusion, serum NGAL, KIM-1, and Cys C levels in Group 3 were significantly lower than those in Group 4. Conclusion: Low-energy shock wave preconditioning can reduce renal ischemic reperfusion injury caused by renal artery occlusion in an isolated kidney rat model.

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“…[12][13][14][15] Although they have typically been demonstrated to be safe, these studies are limited by patient selection bias, small tumours, crude tests used to analyze renal function, and small patient populations. [16][17][18] In effort to reduce our WIT, we used an early clamp release (ECR) technique during laparoscopic partial nephrectomy (LPN). As a measure for quality assessment for this modification in surgical technique, we reviewed prospectively collected data to evaluate the safety of this technique Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function and assessed pre-and post-partial nephrectomy ipsilateral renal function with nuclear renography, serum creatinine, and eGFR.…”

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confidence: 99%

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

Campbell

Chan²,

Luke

2017

CUAJ

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Introduction: Intraoperative warm ischemic time (WIT), associated with hilar clamping during partial nephrectomy (PN), is an established modifiable risk factor for renal dysfunction. We assessed early clamp release (ECR) as a strategy to reduce WIT and assess its impact on renal function and bleeding. Methods: We retrospectively assessed patients who underwent minimally invasive PN by a single surgeon at our centre since December 2011. Comparing the standard technique to an ECR modification, WIT, complications, change in estimated glomerular filtration rate (eGFR), and change in differential function as demonstrated by MAG-3 nuclear renography were assessed. Followup blood work and renograms were performed at 6-12 weeks postoperatively and compared to baseline in 70 patients (35 ECR: 35 control). Results: The ECR and control groups were similar in age, sex, and tumour size, with only patient weight being higher in the ECR group (91.6 vs. 81.6 kg; p<0.05). WIT was significantly lower in ECR group compared to control (18.8 vs. 31.5 minutes; p<0.05). Although there was no significant difference in change from baseline eGFR in the early postoperative period (Day 3) or in followup (6-12 weeks), the control group had a significantly greater loss of ipsilateral renal function from baseline compared to the ECR group (9 vs. 4% change; p<0.05). Blood loss and complication rate were similar between groups. Conclusions: The ECR technique offers a safe, reproducible alternative that reduces WIT during laparoscopic PN. ECR demonstrates a reduction in overall ipsilateral renal dysfunction, without increasing complication or intraoperative bleeding risk.

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Comparison of Total, Selective, and Nonarterial Clamping Techniques During Laparoscopic and Robot-Assisted Partial Nephrectomy

Abstract: Minimally invasive partial nephrectomy without vascular occlusion and with selective arterial clamping is feasible and can be safely performed. With this intermediate-term follow-up there was no clinically significant benefit seen for selective regional or nonischemic techniques.

Cited by 46 publications

References 20 publications

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

Low-energy shock wave preconditioning reduces renal ischemic reperfusion injury caused by renal artery occlusion

Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

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