Impact of "non-clamping technique" on intra- and postoperative course after laparoscopic partial nephrectomy.

Petrasz, P.; Słojewski, Marcin; Sikorski, Andrzej

doi:10.5114/wiitm.2011.30801

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Table 1 summarizes the characteristics of the included studies [ 9 , 15 – 38 ]. Among eligible studies, two were prospective cohort studies (level of evidence: 2b) [ 28 , 35 ], 19 were retrospective studies comparing contemporary series of patients (level of evidence: 3b) [ 9 , 15 , 16 , 18 – 21 , 23 , 25 , 27 , 29 – 34 , 36 – 38 ], and the remaining 4 studies used a historical series as controls (level of evidence: 4) [ 17 , 22 , 24 , 26 ]. A total of 14 studies containing a total number of ≤110 patients were considered as small-sample studies [ 9 , 15 – 20 , 23 , 28 , 29 , 34 – 36 , 38 ], whereas those containing over 110 patients in all were considered as large-sample studies [ 21 , 22 , 24 – 27 , 30 – 33 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Deng

Liu

et al. 2018

BMC Nephrol

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BackgroundOngoing efforts are focused on shortening ischemia intervals as much as possible during partial nephrectomy to preserve renal function. Off-clamp partial nephrectomy (off-PN) has been a common strategy for to avoid ischemia in small renal tumors. Although studies comparing the advantages between off-PN with conventional on-clamp partial nephrectomy (on-PN) have been reported, the impact on short- and especially long-term renal function of the two surgical methods has not been discussed seriously and remained unclear. Our purpose is to evaluate the impact on short- (within postoperative 3 months) and long-term (postoperative 6 months or longer) renal function of off-PN compared with that of on-PN.MethodsWe comprehensively searched databases, including PubMed, EMBASE, and the Cochrane Library, without restrictions on language or region. A systematic review and cumulative meta-analysis of the included studies were performed to assess the impact of the two techniques on short- and long-term renal function.ResultsA total of 23 retrospective studies and 2 prospective cohort studies were included. The pooled postoperative short-term decrease of estimated glomerular filtration rate (eGFR) was significantly less in the off-PN group (weighted mean difference [WMD]: 4.81 ml/min/1.73 m2; 95% confidence interval [CI]: 3.53 to 6.08; p < 0.00001). The short-term increase in creatinine (Cr) level in the on-PN group was also significant (WMD: − 0.05 mg/dl; 95%CI: − 0.09 to − 0.00; p = 0.04). Significant differences between groups was observed for the long-term change and percent (%) change of eGFR (p = 0.04 and p < 0.00001, respectively) but not for long-term Cr change (p = 0.40). The postoperative short-term eGFR and Cr levels, but not the postoperative long-term eGFR, differed significantly between the two groups. The pooled odds ratios for acute renal failure and postoperative progress to chronic kidney disease (stage≥3) in the off-PN group were found to be 0.25 (p = 0.003) and 0.73 (p = 0.34), respectively, compared with the on-PN group.ConclusionsOff-PN exerts a positive impact on the short- and long-term renal function compared with conventional on-PN. Given the inherent limitations of our included studies, large-volume and well-designed RCTS with extensive follow up are needed to confirm and update the conclusion of this analysis.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0993-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Deng

Liu

et al. 2018

BMC Nephrol

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“…Indeed, Petrasz et al [15] began all 38 cases off-clamp, but only 13/38 were completed off-clamp. Whilst off-clamp PN may be beneficial in cases which are completed off-clamp, when patients are converted to on-clamp surgery, outcomes may be inferior when compared to outcomes if the cases had begun on-clamp.…”

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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“…However, the above port placement can be applied when ‘bulldog’ clamps are used for vascular clamping or in patients with small, peripheral masses, where a “non-clamping” technique can be used [11]. The authors use the Satinsky clamp because it does not force a precise and separate dissection of the renal vessels.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery - new experience with port placement.

Panek¹,

Szydełko²,

Lewandowski³

et al. 2013

Videosurgery and Other Miniinvasive Techniques

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The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4th postoperative day. We believe that the proposed way of trocar placement would help to avoid a ‘rollover’ problem between the laparoscope and a Satinsky clamp or a ‘crossing swords’ problem between a Satinsky clamp and manipulators.

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Impact of "non-clamping technique" on intra- and postoperative course after laparoscopic partial nephrectomy.

Cited by 9 publications

References 25 publications

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

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

Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery - new experience with port placement.

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