Is Renal Warm Ischemia over 30 Minutes during Laparoscopic Partial Nephrectomy Possible? One-Year Results of a Prospective Study

Porpiglia, Francesco; Renard, Julien; Billia, Michele; Musso, Fabio; Volpe, Alessandro; Burruni, Rodolfo; Terrone, Carlo; Colla, Loredana; Piccoli, Giorgina Barbara; Podio, Valerio; Scarpa, R.M.

doi:10.1016/j.eururo.2007.04.024

Cited by 151 publications

(86 citation statements)

References 22 publications

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“…The removal of normal parenchyma seems to be a common factor associated with loss in RF. 15,16 We also showed that WIT is strongly associated with loss in RDF. On average, the absolute loss in RDF was 14% and relative loss in RDF was 29% (relative loss = absolute loss RDF/preoperative RDF × 100).…”

Section: Discussionmentioning

confidence: 54%

“…Most studies have based their conclusions on serum creatinine and eGFR, two parameters that do not accurately reflect the damage to the operating kidney. 15 For instance, Porpiglia and colleagues have reported that WIT was associated with loss in RDF, while it did not affect the eGFR, showing the higher sensitivity of RDF to detect renal damage. Since the goal of PN is to preserve RF on the operating kidney, we believe that looking at loss of RDF or eGFR by renal scintigraphy is the best method to identify damage to the operating kidney.…”

Section: Discussionmentioning

confidence: 99%

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Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Pouliot

Imbeault

Shuch

et al. 2013

CUAJ

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Background: Partial nephrectomy (PN) is now the gold standard for the surgical treatment of small renal masses. We evaluated the effect of WIT and other factors on RDF assessed by preoperative and postoperative renal scintigraphy. Methods: Between 2003 and 2008, 182 consecutive laparoscopic PN (LPN) were performed in an academic centre. Among those, 56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy preoperatively and postoperatively. Results: Medians for age, preoperative estimated glomerular filtration rate and computed tomography scan tumour size were 62 years, 82 mL/min/1.73m 2 and 26 mm, respectively. Median WIT and preoperative RDF were 30 minutes and 50%, respectively. Median loss of RDF after surgery was 14%. Linear regression curves showed that loss in RDF rate was 0.2% per minute when WIT was <30 minutes and 0.7% per minute when WIT was ≥30 minutes. In multivariate analysis, length of WIT and endophytic tumour location were associated with a statistically significant loss of RDF (p < 0.05), but only in the group who experienced >30 minutes of WIT. Interpretation: Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Pouliot

Imbeault

Shuch

et al. 2013

CUAJ

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“…This damage is only partially reversible and efforts should be made to keep the WIT within 30 minutes. 29,30 The optimal WIT should be 20 or 25 minutes. Moreover, robot assistance tends to shorten the duration of WIT as compared to pure LPN.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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“…El Tiempo de Isquemia Caliente (TIC) es un factor fundamental que se controla con celo. Se considera que el límite superior del tiempo de isquemia aceptable es de 30 min 12 . Porpiglia 12 et al estudiaron una serie de 18 pacientes con un TIC 430 min.…”

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Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura

Eizaguirre

Piédrola

Abad

et al. 2010

Actas Urológicas Españolas

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Is Renal Warm Ischemia over 30 Minutes during Laparoscopic Partial Nephrectomy Possible? One-Year Results of a Prospective Study

Cited by 151 publications

References 22 publications

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Nefrectomía parcial laparoscópica. Análisis de los primeros 30 casos de nuestra serie y revisión de la literatura

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