Laparoscopic Partial Nephrectomy for Reanl Tumor: Single Center Experience Comparing Clamping and No Clamping Techniques of the Renal Vasculature

Guillonneau, Bertrand; Bermúdez, Hugo; Gholami, Shahram S.; Fettouh, H. El; Gupta, Roby; Rosa, J. Adorno; Baumert, H.; Cathelineau, Xavier; Fromont, Gaëlle; Vallancien, Guy

doi:10.1016/s0022-5347(05)63939-0

Cited by 179 publications

(56 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Given that decreased blood loss is often cited as a reason to pursue hilar clamping, relatively small amounts of blood loss (mean 158 cc in our experience) is quite reassuring. 21 Furthermore, there was a minimal increase in creatinine after surgery in our patients (mean 9.2%), indicating little effect on renal function postoperatively. Notably, postoperative renal function is multifactorial relative to preoperative function, preserved renal mass, and intra-operative renal ischemia.…”

Section: Discussionmentioning

confidence: 50%

Zero Ischemia Robotic-Assisted Partial Nephrectomy in Alberta: Initial Results of a Novel Approach

Forbes

Cheung

Kinnaird

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction: Partial nephrectomy remains the standard of care in early stage, organ-confined renal tumours. Recent evidence suggests that minimally invasive surgery can proceed without segmental vessel clamping. In this study, we review our experience at a Canadian centre with zero ischemia robotic-assisted partial nephrectomy (RAPN). Methods: A retrospective chart review of zero ischemia RAPN was performed. All surgeries were consecutive partial nephrectomies performed by the same surgeon at a tertiary care centre in Northern Alberta. The mean follow-up period was 28 months. These outcomes were compared against the current standards for zero ischemia (as outlined by the University of Southern California Institute of Urology [USC]). Results: We included 21 patients who underwent zero ischemia RAPN between January 2012 and June 2013. Baseline data were similar to contemporary studies. Twelve (57.1%) required no vascular clamping, 7 (33.3%) required clamping of a single segmental artery, and 2 (9.5%) required clamping of two segmental arteries. We achieved an average estimated blood loss of 158 cc, with a 9.2% average increase in creatinine postoperatively. Operating time and duration of hospital stay were short at 153 minutes and 2.2 days, respectively. Conclusion: Zero ischemia partial nephrectomy was a viable option at our institution with favourable results in terms of intra-operative blood loss and postoperative creatinine change compared to results from contemporary standard zero ischemia studies (USC). To our knowledge, this is the first study to review an initial experience with the zero ischemia protocol in robotic-assisted partial nephrectomies at a Canadian hospital.

show abstract

Section: Discussionmentioning

confidence: 50%

Zero Ischemia Robotic-Assisted Partial Nephrectomy in Alberta: Initial Results of a Novel Approach

Forbes

Cheung

Kinnaird

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…However, in larger resections, combination with other techniques might be necessary to decrease blood loss and the rate of complications. Several institutions have recently had technical success with laparoscopic partial nephrectomy that duplicates open surgical techniques and involves transient clamping of the renal parenchyma [13][14][15]. Although demanding, the wide applicability of this procedure is superior to using microwave tissue coagulation.…”

Section: Discussionmentioning

confidence: 99%

Impact of microwave tissue coagulation during laparoscopic partial nephrectomy on postoperative renal function

et al. 2007

View full text Add to dashboard Cite

Laparoscopic partial nephrectomy for small renal tumors has been performed with increasing frequency over the past few years. We prospectively evaluated preoperative and postoperative differential renal function in patients with functioning contralateral kidneys who underwent laparoscopic partial nephrectomy using a microwave tissue coagulator without hilar clamping. Seven patients (five men and two women) in this prospective protocol underwent laparoscopic partial nephrectomy for exophytic tumors using a microwave tissue coagulator when the tumor was 2 cm or less in diameter. Renal scanning with 99technetium-labeled diethylenetetraminepentaacetic-acid scan was performed preoperatively and postoperatively at 7 days and 6 months after surgery in all patients. The mean tumor size and surgical duration were 17.0 +/- 2.3 mm and 161.1 +/- 20.5 min, respectively. Intraoperative blood loss was 35.6 +/- 40.7 ml. The preoperative glomerular filtration rate (GFR) and differential split renal function (SF) in the affected kidney were 45.7 +/- 12.8 ml/min and 50.5 +/- 3.3%, respectively. On postoperative day 7 and at 6 months, GFR and SF in the affected kidney were 36.2 +/- 9.0 and 36.8 +/- 10.9 ml/min and 44.3 +/- 4.1 and 45.0 +/- 5.1%, respectively. No postoperative complications occurred. Laparoscopic nonischemic partial nephrectomy using a microwave tissue coagulator has the advantage of technical ease and adequate hemostasis. However, its indication should be restricted to small exophytic renal tumors due to the expected collateral damage causing renal impairment.

show abstract

“…A recent comparison of 100 patients undergoing LPN with expanded indications showed a slightly higher rate of intraoperative complications in the laparoscopic group compared to the open group (5% vs 0%, respectively), no differences in the overall rate of postoperative complications (13% vs 16%, respectively), and a higher rate of urologic complications (11% vs 2%, respectively) [19•]. Other reported complication rates range from 10% to 21% [20,21]. Special points Laparoscopic partial nephrectomy is an effective minimally invasive nephron-sparing approach for select small renal tumors.…”

Section: Laparoscopic Partial Nephrectomymentioning

confidence: 99%

Laparoscopic approaches to urologic malignancies

Matin

2003

Curr. Treat. Options in Oncol.

View full text Add to dashboard Cite

Urologic laparoscopy has had its greatest impact on patients with genitourinary malignancies. Only pelvic lymph node dissection and the occasional nephrectomy were considered oncologically feasible early in the evolution of laparoscopic urology. Presently, multiple approaches are considered standard at centers of excellence and in the general community. Laparoscopic adrenalectomy and radical nephrectomy have gained overwhelming acceptance. Laparoscopic cytoreductive nephrectomy has been found to be feasible for select patients with metastatic renal cell carcinoma. Minimally invasive nephron-sparing approaches, such as cryoablation, radiofrequency ablation, and laparoscopic partial nephrectomy, continue to generate great interest, but follow-up remains limited. Early data with laparoscopic radical prostatectomy suggest excellent continence rates and equivalent oncologic results based on pathologic surrogates of cure. However, long-term data are still needed, in addition to validated information regarding return of erectile function and quality of life. Other novel therapies, such as laparoscopic radical cystectomy with urinary diversion and laparoscopic retroperitoneal lymph node dissection, hold great promise of benefiting patients with urologic malignancies.

show abstract

Laparoscopic Partial Nephrectomy for Reanl Tumor: Single Center Experience Comparing Clamping and No Clamping Techniques of the Renal Vasculature

Abstract: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time.

Cited by 179 publications

References 19 publications

Zero Ischemia Robotic-Assisted Partial Nephrectomy in Alberta: Initial Results of a Novel Approach

Zero Ischemia Robotic-Assisted Partial Nephrectomy in Alberta: Initial Results of a Novel Approach

Impact of microwave tissue coagulation during laparoscopic partial nephrectomy on postoperative renal function

Laparoscopic approaches to urologic malignancies

Contact Info

Product

Resources

About