Laparoscopic Partial Nephrectomy With Segmental Renal Artery Clamping: Technique and Clinical Outcomes

Shao, Pengfei; Qin, Chao; Chen, Yin; Meng, Xia; Ju, Xingrong; Li, Jie; Lv, Qiang; Zhang, Wei; Xu, Zuo-Feng

doi:10.1016/j.eururo.2010.11.037

Cited by 163 publications

(150 citation statements)

References 24 publications

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“…Эффективность такого подхода при лапароскопических операциях была продемонстрирована в эксперименте на животных [15]. В последнее время появились первые, но весь-ма обнадеживающие сообщения об использовании локальной ишемии при лапароскопической резек-ции почки в клинике [7]. Мы сравнили влияние почки тотальной и се-лективной тепловой ишемии при резекции поч-ки на СКФ после операции.…”

Section: результаты и обсуждениеunclassified

“…Пережатие по-чечных сосудов во многих случаях оказывается необ-ходимым для уменьшения кровопотери, достижения надежного гемостаза и восстановления коллектор-ной системы. Однако каждая минута тепловой ише-мии сопровождается увеличением риска нарушения функции почки [5][6][7][8][9]. Традиционно зажим накла-дывают на почечную артерию (ПА) или пережима- Organ-preserving laparoscopic surgeries for renal cancer with the use of segment-by-segment ischemia ют почечную ножку ad mass.…”

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“…Временное пережатие отдельных ветвей ПА может существенно сократить ишемическое повреждение за счет сохранения кро-вотока в большей части органа. В то же время пре-кращение кровотока в пораженном сегменте орга-на позволяет избежать значительной кровопотери, способствует хорошей визуализации операцион-ного поля, надежному гемостазу и восстановлению целостности чашечно-лоханочной системы при ее вскрытии [7,10]. В ряде случаев можно выполнить дальнейшую субсегментарную диссекцию ПА до ветвей 2-4-го порядка и таким образом обойтись суперселективной ишемией, тем самым еще более снижая риск нарушения функции органа [7,11].…”

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Organ-preserving laparoscopic surgeries for renal cancer with the use of segment-by-segment ischemia

Перлин¹,

Sapozhnikov²,

Зипунников³

et al. 2014

Endosk. khir.

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В течение последних лет доля эндоскопических операций при онкоурологических заболеваниях продолжает неуклонно расти, что обусловлено не только хорошим косметическим и функциональ-ным эффектом, но и совершенствованием видео-техники, позволяющей в настоящее время получать многократно увеличенное изображение высокого разрешения, существенно расширяя возможности органосохраняющего лечения. Онкологические ре-зультаты резекций почки, выполненных по поводу почечно-клеточного рака, не уступают результатам открытых операций [1][2][3][4]. В то же время продолжи-тельность тепловой ишемии при лапароскопических операциях все еще превышает таковое при выполне-нии резекций открытым доступом. Пережатие по-чечных сосудов во многих случаях оказывается необ-ходимым для уменьшения кровопотери, достижения надежного гемостаза и восстановления коллектор-ной системы. Однако каждая минута тепловой ише-мии сопровождается увеличением риска нарушения функции почки [5][6][7][8][9]. Традиционно зажим накла-дывают на почечную артерию (ПА) или пережима-

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Section: результаты и обсуждениеunclassified

unclassified

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Organ-preserving laparoscopic surgeries for renal cancer with the use of segment-by-segment ischemia

Перлин¹,

Sapozhnikov²,

Зипунников³

et al. 2014

Endosk. khir.

View full text Add to dashboard Cite

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“…We know that partial nephrectomy is the treatment of choice for small, localized renal tumors [8] , and it is generally performed with occlusion of kidney vascular supply, leading to IRI. To reduce this kind of injury, several methods are proposed and investigated in the literature such as early hilar unclamping [9] , renal hypothermia [10] , segmental renal artery clamping [11] , and selective branch microdissection [12] (beyond the scope of this review), and IPC [13] . IPC is a phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Robotic and laparoscopic urologic surgery ischemic preconditioning

Zor¹,

Ozgok-Kangal²

2018

MIS

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Laparoscopic and robotic assisted surgeries have evolved from a limited surgical procedure to a major surgical technique during the last three decades. The indications increased incrementally. Despite its several advantages, it has some surgery and pneumoperitoneum related adverse effects and hemodynamic complications. One of them is the ischemia reperfusion injury (IRI) of the abdominal organs that can be developed secondary to pneumoperitoneum. IRI is also a risk factor for acute kidney injury in partial nephrectomy surgeries even performed via open, or laparoscopic/ robotic assisted. To reduce or avoid the IRI related complications during laparoscopy and robotics, several alternative approaches were suggested including ischemic preconditioning (IPC). IPC is a phenomenon that promotes tissue tolerance to ischemia. Since it was first introduced, several studies evaluating its protective effects or mechanism of action have been published. Majority of them demonstrated its potent beneficial effects against IRI. Despite these favorable results, IPC has not yet been used in clinical settings routinely. The unknown parts of the exact mechanisms, the lack of standard protocols for its use such as the duration of clamping, the number of clamping cycles, using an early window or a late window, using local IP or remote IP, and the all remaining uncertainly about these aspects of the process might lead clinicians to be hesitant about its clinical use. In this study we discussed what we have in our hands regarding the effects of IRI and protective mechanisms of IPC, animal studies and clinical evidence of IPC, remote and local IPC, laparoscopy/robotics induced IRI, and role of laparoscopic/robotic IPC.

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“…Retrospective studies have shown that unclamped PN in patients with two normal kidneys results in a lesser degree of postoperative eGFR decline at 1 year. 68,69 Other techniques include segmental 70 and subsegmental artery dissection and microclamping 71,72 whereby, after hilar exposure, segmental and subsegmental arteries are dissected under laparoscopic Doppler ultrasound guidance. The peritumoral arteries identified are then superselectively clamped using a micro-bulldog clamp.…”

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confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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Laparoscopic Partial Nephrectomy With Segmental Renal Artery Clamping: Technique and Clinical Outcomes

Cited by 163 publications

References 24 publications

Organ-preserving laparoscopic surgeries for renal cancer with the use of segment-by-segment ischemia

Organ-preserving laparoscopic surgeries for renal cancer with the use of segment-by-segment ischemia

Robotic and laparoscopic urologic surgery ischemic preconditioning

Laparoscopic partial nephrectomy: state of the art review

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