Every Minute Counts When the Renal Hilum Is Clamped During Partial Nephrectomy

Thompson, R. Houston; Lane, Brian R.; Lohse, Christine M.; Leibovich, Bradley C.; Fergany, Amr; Frank, Igor; Gill, Inderbir S.; Blute, Michael L.; Campbell, Steven C.

doi:10.1016/j.eururo.2010.05.047

Cited by 650 publications

(459 citation statements)

References 19 publications

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“…Functional results of PN have demonstrated that renal damage and subsequent loss of renal function occur even in cases of lower WIT, demonstrating that every minute counts when renal hilum is clamped (3,16).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…Current understanding of renal ischemia is derived from animal studies, the renal transplant setting, and retrospective human studies that report conflicting data regarding the response and tolerance of the human kidney to ischemia. [1][2][3][4][5][6] These studies suggest harmful effects from renal ischemia, resulting in the present dogma of limiting renal ischemia time during surgical procedures to within 20-30 minutes. 6 Clinical trials in the field of AKI based on promising animal data have disappointed, suggesting that the human and small-animal kidney responses to ischemia may be qualitatively and quantitatively different.…”

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confidence: 99%

Tolerance of the Human Kidney to Isolated Controlled Ischemia

Parekh¹,

Weinberg²,

Ercole

et al. 2013

Journal of the American Society of Nephrology

181

149

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Tolerance of the human kidney to ischemia is controversial. Here, we prospectively studied the renal response to clamp ischemia and reperfusion in humans, including changes in putative biomarkers of AKI. We performed renal biopsies before, during, and after surgically induced renal clamp ischemia in 40 patients undergoing partial nephrectomy. Ischemia duration was .30 minutes in 82.5% of patients. There was a mild, transient increase in serum creatinine, but serum cystatin C remained stable. Renal functional changes did not correlate with ischemia duration. Renal structural changes were much less severe than observed in animal models that used similar durations of ischemia. Other biomarkers were only mildly elevated and did not correlate with renal function or ischemia duration. In summary, these data suggest that human kidneys can safely tolerate 30-60 minutes of controlled clamp ischemia with only mild structural changes and no acute functional loss.

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“…Indeed, in a recent single-center series evaluating the short-and long-term renal effect on 362 patients with RCC in a solitary kidney, for each 1 min of increasing of WIT there was a 5% increased in the risk of postoperative acute renal failure. Moreover, evaluating warm ischemia in 5-min increments, a cutoff point of 25 min provided the best stratification of risk of developing acute renal failure or an acute GFR <15 ml/min or a new-onset stage IV chronic kidney disease in the postoperative period [23].…”

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confidence: 99%