Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Cheng, KC; Yiu, MK; Sh, Ho; Tl, Ng; Tsu, HL; Ma, WK

doi:10.12809/hkmj154746

Cited by 3 publications

(5 citation statements)

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“…9 A warm ischemia time of >20-25 minutes is associated with greater risk of acute and chronic renal injury with need of hemodialysis in future. 7,9,[23][24][25] In our study, the hilar clamping group had WIT of 19 minutes which is considerably lower compared to other studies. Cheng et al 23 noted significant deterioration in eGFR for hilar clamping compared to selective renal parenchymal clamping but this benefit did not translate into long-term (90 days) renal function improvement.…”

Section: Despite Introduction Of Minimally Invasive Surgery Over the Last Two Decades Open Partialcontrasting

confidence: 79%

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

et al. 2020

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Background and Objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function. Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients’ demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients’ renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22. Results: Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05±1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively). Conclusion: Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function. doi: https://doi.org/10.12669/pjms.36.3.1533 How to cite this:Jalbani IK, Nazim SM, Ahmed M, Abbas F. Nephron sparing surgery for renal tumors- comparison of off-clamp partial nephrectomy with hilar clamping. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1533 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Despite Introduction Of Minimally Invasive Surgery Over the Last Two Decades Open Partialcontrasting

confidence: 79%

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

et al. 2020

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“…Efforts to minimize WI time resulted to the introduction of terms like early unclamping technique, selective clamping technique, clampless PN, and selective renal parenchymal ischemia [6,10]. Technique of selective renal parenchymal ischemia has been described by many authors who used different surgical tools or applied manual compression, which was firstly described by Semb in 1956 [10]. Selective renal parenchymal ischemia is indicated for tumors which are exophytic and are peripherally located [10].…”

Section: Discussionmentioning

confidence: 99%

“…Technique of selective renal parenchymal ischemia has been described by many authors who used different surgical tools or applied manual compression, which was firstly described by Semb in 1956 [10]. Selective renal parenchymal ischemia is indicated for tumors which are exophytic and are peripherally located [10]. There is no need for pedicle dissection and global renal ischemia which are technically challenging and time-consuming and may impede postoperative renal function [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Selective renal parenchymal ischemia is indicated for tumors which are exophytic and are peripherally located [10]. There is no need for pedicle dissection and global renal ischemia which are technically challenging and time-consuming and may impede postoperative renal function [10,11]. Furthermore, controlling kidney's position is easy and it allows applying different degrees of compression quickly during tumor's resection and renal reconstruction, which facilitates the procedure [10].…”

Section: Discussionmentioning

confidence: 99%

“…There is no need for pedicle dissection and global renal ischemia which are technically challenging and time-consuming and may impede postoperative renal function [10,11]. Furthermore, controlling kidney's position is easy and it allows applying different degrees of compression quickly during tumor's resection and renal reconstruction, which facilitates the procedure [10]. Following the first operation, we had to face two tumors of the contralateral kidney, one of which was sizable, and to prevent additional renal injury.…”

Section: Discussionmentioning

confidence: 99%

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Multiple and bilateral sporadic renal cell carcinomas: A surgical challenge

Klapsis¹,

Katsimantas²,

Zervopoulos³

et al. 2018

European Urology Supplements

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Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient's estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.

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Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge

Katsimantas

Paparidis

Bouropoulos

et al. 2018

Case Reports in Urology

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Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient's estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.

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Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Cited by 3 publications

References 16 publications

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

Multiple and bilateral sporadic renal cell carcinomas: A surgical challenge

Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge

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