Reducing Warm Ischaemia Time During Laparoscopic Partial Nephrectomy: A Prospective Comparison of Two Renal Closure Techniques

Baumert, H.; Ballaro, A.; Shah, Nimish; Mansouri, Dhouha; Zafar, Nauman; Molinié, Vincent; Neal, David E.

doi:10.1016/j.eururo.2007.03.060

Cited by 132 publications

(56 citation statements)

References 18 publications

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“…A notable single centre series examining the impact of EUC on WIT in RAPN reported a significant reduction in WIT with no additional morbidity, despite slightly higher blood loss [37]. Although the difference in WIT was not as significant in this study as in those reported in the context of LPN, this partly reflects shorter baseline WIT in RAPN with conventional clamping strategies [36,37].…”

Section: Early Unclampingcontrasting

confidence: 57%

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Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

2017

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This article aims to summarise recent developments in surgical and minimally invasive therapies in the management of small renal masses (SRM). Recent FindingsThe incidence of the small renal mass is increasing. Standard management of the SRM is partial nephrectomy. More recently, use of ablative techniques to manage the SRM has been increasing and an exciting array of technical advances are currently being made in the field.Nephron-sparing surgery looks set to become more financially viable with the advent of newer robotic platforms and, potentially even less invasive with the evaluation of single-port access. Real-time imaging promises to improve tumour definition, nephron preservation and vascular management intraoperatively. SummaryAdvances in surgical and minimally invasive therapies for the management of the SRM have the potential to improve cancer clearance and long-term renal function preservation. Patients will experience safer, more reliable and less invasive treatments for their small renal tumours. We describe the current advances underlying these changes.

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Section: Early Unclampingcontrasting

confidence: 57%

“…EUC refers to the removal of clamps after one or two running sutures to the tumour bed, but before closure of the renal capsule [36]. A notable single centre series examining the impact of EUC on WIT in RAPN reported a significant reduction in WIT with no additional morbidity, despite slightly higher blood loss [37].…”

Section: Early Unclampingmentioning

confidence: 99%

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

2017

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“…The critic threshold for the beginning of such damage has been extensively studied and fixed around 20-25 minutes (2). Nevertheless, recent studies demonstrated that every minute is crucial in determining renal damage during renal ischemia (3) and stimulated surgeons towards the introduction of new technical tricks in order to further reduce warm ischemia time (WIT) (4,5) and lead to the conception of the development of LPN performed with "zero-ischemia"-Vol. 38 (4): 480-488, July -August, 2012 technique, with the aim of completely eliminate surgical renal ischemia.…”

Section: Introductionmentioning

confidence: 99%

Clampless laparoscopic partial nephrectomy: a step towards a harmless nephron-sparing surgery?

et al. 2012

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ARTIcLE INFO _________________________________________________________ ___________________Purpose: To evaluate the results of our technique of clampless laparoscopic partial nephrectomy (LPN) and its impact as an emerging treatment for small renal masses (SMRs). Materials and Methods:We reviewed our prospectively maintained database: data of 117 patients who consecutively underwent LPN at our Institution from January 2009 to December 2011 were studied. Patients were divided into 2 Groups based on operative technique: Group A: clampless-LPN (cl-LPN); Group B: conventional LPN (clamping of renal artery). Demographic and peri-operative data, complications, pre-and post-operative serum creatinine and estimated glomerular filtration rate (eGFR) were registered and compared by Student's t-and Chi-square-tests (p-values < 0.05 considered statistically significant).

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“…Our outcomes are reassuring, as complication rates are similar to other LPN series. 16 By comparison, off-clamp or selective clamping PNs have been reported to be associated with higher EBL and complication rates. 11,17,27 In the past, techniques permitting reduced clamp time were performed in selected patients with smaller tumours and lower nephrometry scores, whereas in our study, no selection bias occurred, since the technique was applied to all LPN cases in succession.…”

Section: Discussionmentioning

confidence: 99%

“…[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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Reducing Warm Ischaemia Time During Laparoscopic Partial Nephrectomy: A Prospective Comparison of Two Renal Closure Techniques

Cited by 132 publications

References 18 publications

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

Clampless laparoscopic partial nephrectomy: a step towards a harmless nephron-sparing surgery?

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

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