Non‐clamped partial nephrectomy: techniques and surgical outcomes

Abstract

and 192 PNs done without clamping (group B). The median tumour size was slightly larger in group B than in group A (3.0 vs 2.8 cm, P = 0.002).• There was no difference in preoperative eGFR ( P = 0.304) or the prevalence of solitary kidney ( P = 0.69).• Median estimated blood loss was 300 mL higher in the unclamped group ( P < 0.001) and was associated with a higher rate of transfusion ( P = 0.001). There was no difference the positive margin rate or rate of recurrence ( P = 0.60).• The median percentage change in eGFR was a 12.3% decrease for group A and a 9.8% decrease for group B at 1 year ( P = 0.037). In the subset of patients with solitary kidneys, the median change in eGFR was a 21% decrease in group A and a 4.4% decrease in group B at 1 year ( P = 0.027).• The rate of complications was similar in groups A and B (11.2 vs 9.9%, P = 0.72). There were no perioperative deaths.

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

“…Indeed, Thompson et al [19] completed 92/96 (96%) off-clamp cases by open surgery, whilst 319/362 (88%) in the on-clamp group had open surgery and the remainder laparoscopically. Smith et al [17] completed all off-clamp cases laparoscopically, whilst in the on-clamp group, 51/116 (44%) patients had open surgery, 57/116 (49.1%) had laparoscopic surgery and 8/116 (0.9%) had robotic surgery. Most studies failed to state the exact follow-up period when postoperative renal function was measured for each group.…”

Tolerance of the Human Kidney to Isolated Controlled Ischemia

“…18 Several technically challenging nonclamping approaches have been recently proposed to avoid renal ischemia, with significantly higher complication rates. 19,20 Using open partial nephrectomy for excision of a renal mass involving direct clamp occlusion of the renal blood vessels, we have conducted a prospective study that evaluates for the first time the structural response of the human kidney to clamp ischemia and initial reperfusion in association with assessment of short-term renal functional outcomes and novel biomarkers. Our results document substantial resistance of the human kidney to clamp ischemia and have implications for both the basic understanding of ischemic injury in human kidneys and the care of patients requiring isolated controlled ischemia for partial nephrectomy and other procedures.…”

Novel Renal Transplant-Related Surgical Approaches in the 21st Century

“…Duration of ischemia is found to be the strongest modifiable risk factor for decrease renal function after partial nephrectomy (Lane, et al, 2011). Libertino described his technique for partial nephrectomy without vascular occlusion essentially achieving a 0-ischemia time (Smith, et al, 2010). The renal vessels are dissected all the way to the level of the intrarenal branches.…”