Laparoscopic Partial Nephrectomy: Effect of Warm Ischemia on Serum Creatinine

Bhayani, Sam B.; Rha, Koon Ho; Pinto, Peter A.; Ong, Albert M.; Allaf, Mohamad E.; Trock, Bruce J.; Jarrett, Thomas W.; Kavoussi, Louis R.

doi:10.1097/01.ju.0000138187.56050.20

Cited by 153 publications

(84 citation statements)

References 16 publications

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“…While some studies have found that the impact of shortterm warm ischemia upon postoperative renal function is negligible, 5,6 and compares favorably to total loss of the renal unit by radical nephrectomy, 7 it is possible that the renal reserve provided by a normal contralateral kidney may mask the loss of renal function to a considerable degree. Indeed, studies evaluating functional outcomes of partial nephrectomy in the setting of a solitary kidney favor the open approach, as cold ischemia and shorter overall ischemic times appear to provide superior preservation of functional renal reserve.…”

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confidence: 99%

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Benway

Baca

Bhayani

et al. 2009

Journal of Endourology

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Diaz, Dilmer L.; Maxwell, Keegan L.; Badwan, Khalid H.; Talcott, Michael R.; Liapis, Helen; Cabello, Jose M.; Venkatesh, Ramakrishna; and Figenshau, Robert S., ,"Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: Impact upon renal function in the setting of a solitary kidney in a porcine model." Journal of Endourology.23,7. 1127Endourology.23,7. -1133Endourology.23,7. . (2009 Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week.Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60-and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

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Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Benway

Baca

Bhayani

et al. 2009

Journal of Endourology

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“…18,19 Moreover, in retrospective studies, the warm ischemia of 40 to 55 minutes was safe and sufficient for the complete recovery of renal function. 20,21 Lee and colleagues demonstrated that ultimate renal function decreases proportionally with increasing ischemia time in the warm and cold ischemia groups. 22 Accordingly, we believe that our results provide information on the correlation between the anatomical features of renal tumours and the functional outcomes of RAPN.…”

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confidence: 99%

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Lee

Cho

Jeon

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e810-4. http://dx.doi.org/10.5489/cuaj.1642 Published online November 24, 2014. AbstractIntroduction: We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN). Methods: We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases. Results: A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN. Conclusions: The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

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“…The "safe" window of warm ischemia time is unknown despite several studies assessing its impact. [10][11][12][13] In this series none of the patients had preoperative baseline creatinine Ͼ2.0 mg/dL, so clearly the population was somewhat selected for tolerance of ischemia. Importantly, however, warm ischemia times were relatively short.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy: Fifty Cases

Bhayani

2008

Journal of Endourology

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Purpose: Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure. The goal of this study is to describe the outcomes of 50 consecutive patients undergoing LPN performed by one surgeon.Materials and Methods: Records were reviewed for clinical, pathologic, and follow-up information for patients undergoing LPN. Clinical parameters were assessed in both the first 25 and last 25 cases to see if there was a measurable learning curve.Results: Fifty-two patients underwent attempted LPN; 50 were successful and 2 were converted to open partial nephrectomy. Mean operating room time was 155 minutes, mean estimated blood loss was 172 mL, and mean pathologic size was 2.6 cm. Final pathology revealed malignancy in 60% of cases and oncocytoma in 22% of cases. Margins were clear for all of the primary lesions. Overall complications were 16%, with cardiopulmonary complications being the most common. There were no significant differences in the outcomes of the first 25 and the last 25 patients, with the exception of length of stay (3.1 days v 2.5 days).Conclusions: After laparoendoscopic fellowship training in LPN, acceptable outcomes are achievable, and the learning curve is minimal. Long-term studies are needed on the efficacy of LPN, and further studies need to be performed to optimize the learning process for this technique.

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Laparoscopic Partial Nephrectomy: Effect of Warm Ischemia on Serum Creatinine

Cited by 153 publications

References 16 publications

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Laparoscopic Partial Nephrectomy: Fifty Cases

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