Initial Experience in Laparoscopic Partial Nephrectomy for Renal Tumor with Clamping of Renal Vessels

Bermúdez, Hugo; Guillonneau, Bertrand; Gupta, Roby; Rosa, J. Adorno; Cathelineau, Xavier; Fromont, Gaëlle; Vallancien, Guy

doi:10.1089/089277903767923146

Cited by 39 publications

(10 citation statements)

References 18 publications

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“…Nephron-sparing surgery is an effective and reliable treatment in low stage renal tumors [1] . Clamping the renal pedicle allows better visualization, helping accurate tumor excision and hemostatic suturing of the parenchymal defect [2] , however it entails renal ischemia and sometimes leads to ischemic injury when it is prolonged. In previous studies measuring serum creatinine, Bhayani et al [3] showed that warm ischemic time up to 55 min did not significantly influence longterm renal function after LPN.…”

Section: Introductionmentioning

confidence: 99%

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Tachikake

Shigeta²,

Mita³

et al. 2009

Urol Int

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Introduction: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid (^99mTc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. Patients and Methods: The ^99mTc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: ≤40 min, B: >40 min ∩ ≤60 min, C: >60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. Results: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). Conclusion: Renal function calculated by ^99mTc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

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Section: Introductionmentioning

confidence: 99%

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Tachikake

Shigeta²,

Mita³

et al. 2009

Urol Int

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“…A number of clinical scenarios exist where information like that obtained in this work has potential impact. The transplant and laparoscopic literature report that there is a lack of knowledge regarding the vascular pedicle and renal ostium relative to the aorta, which may potentially affect laparoscopic renal transplant surgery and laparoscopic nephrectomies (Bermudez et al, 2003). CTA has been shown to be useful in the assessment of prospective living renal donors (Rydberg et al, 2001;Fleischmann, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…The orientation of the renal vascular pedicle is important for laparoscopic urologic procedures like donor nephrectomy (Bermudez et al, 2003). The right pedicle has *42.98 anteromedial orientation with a three-degree difference resulting in more anterior orientation for women.…”

Section: Discussionmentioning

confidence: 99%

Normal renal arterial anatomy assessed by multidetector CT angiography: Are there differences between men and women?

et al. 2009

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The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p < .001). There was no statistical significance for the renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development.

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“…Lower set: Conventional suturing with tangential transmission of force which can result in 'cheese cutting' effect and has its own risks [9]. Infusion of a cold solution at 4°C delivered via a ureteral catheter could also be used [10], but the efficacy of this has not been extensively tested.…”

Section: Cold Ischemiamentioning

confidence: 99%

A Review of Methods for Hemostasis and Renorrhaphy After Laparoscopic and Robot-assisted Laparoscopic Partial Nephrectomy

Rajan

Leveillee

2010

Curr Urol Rep

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The techniques for management of small renal masses (SRMs) have evolved over the past several years. Radical nephrectomy can lead to an increased risk of chronic kidney disease, and the emphasis is now shifting to nephron-conserving techniques. Partial nephrectomy is now considered a standard of care for the management of SRMs, and laparoscopic techniques are becoming popular because they are minimally invasive. The kidneys are extremely vascular organs, and renal hemorrhage is a major cause of morbidity after laparoscopic partial nephrectomies. Control of bleeding and management of calyceal injuries can be difficult and make the procedure technically challenging. This review looks at the various modalities that are available to reduce bleeding and reviews some advances in the area of hemostatic maneuvers during laparoscopic partial nephrectomies.

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Initial Experience in Laparoscopic Partial Nephrectomy for Renal Tumor with Clamping of Renal Vessels

Cited by 39 publications

References 18 publications

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Normal renal arterial anatomy assessed by multidetector CT angiography: Are there differences between men and women?

A Review of Methods for Hemostasis and Renorrhaphy After Laparoscopic and Robot-assisted Laparoscopic Partial Nephrectomy

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