<p>Long-term renal function following zero ischemia partial nephrectomy</p>

Abstract

Partial nephrectomy (PN), also known as nephron sparing surgery, is considered as the first-line treatment in small renal masses, especially in T1/2 tumors, and is applied as a standard treatment in advanced centers. The main expected outcomes from an ideal PN are surgical margin negativity, minimal impairment in renal function, and any surgical complications. Many authors have defined PN techniques as “zero ischemia partial nephrectomy”, where surgery is performed without clamping the main renal artery in order to protect the renal parenchyma from ischemic injury. Various PN techniques employed by surgeons include: selective or segmental renal artery clamping technique; off-clamp, clampless, or unclamped technique; preoperative superselective transarterial tumor embolization technique; sequential/modified sequential preplaced suture renorrhaphy technique, radio frequency ablation-assisted technique, and combination of these techniques. The common goal of all these techniques is to provide zero ischemia without hilar clamping. This systematic review focuses on the long-term functional outcomes of PNs performed by zero ischemia techniques.

Raw and cooked aqueous and methanol extracts of Vigna unguiculata (black-eyed bean) enhances renal function in experimental Wister rats

“…Clinically, assessment of kidney function to urea measurement is less significant since blood urea can rise in clinical conditions devoid of kidney diseases such as bleeding in the upper gastrointestinal tract (Boga and Sönmez, 2019), high protein diet, dehydration and catabolism; or decline in liver disease (severe; Nwose et al , 2019), poor protein diet and starvation (Okoro and Farate, 2019). A normal functioning kidney filters the blood with urea nitrogen, but in kidney failure, the level of urea in the blood builds up (Rusul and Haider, 2014).…”

Changes in kidney function according to ischemia type during partial nephrectomy for T1a kidney cancer

“…Several studies on robotic-assisted or laparoscopic partial nephrectomy have reported that techniques such as off-clamping, selective-clamping, or on-clamping do not affect functional outcomes [17][18][19] . On the contrary, some studies provide supporting evidence on the hypothesis that ischemia techniques such as cold ischemia, off-clamping, or www.nature.com/scientificreports/ selective vascular clamping are beneficial to preserve postoperative renal function 1,6,[20][21][22][23][24] . Riccardo Bertolo et al endeavored to compare the functional outcomes between off-clamped and on-clamped robot-assisted partial nephrectomy, and showed that the off-clamp is more favorable to preserve postoperative eGFR than clamping the renal hilum 9 .…”

“…However, Riccardo Bertolo et al found that off-clamp showed a tendency towards better renal function recovery after partial nephrectomy than cold ischemia and warm ischemia technique 9 . Boga et al also reviewed that impairment of renal function in selective renal artery clamping technique and off-clamping technique was less significant than on-clamping 22 . Our study rather argues that zero/selective ischemia technique can be regarded as superior to cold ischemia technique.…”

How to improve outcome in nephron-sparing surgery: the impact of new techniques

“…Compared with hilar clamping, it is associated with an improved postoperative renal function, without increasing the risk of complications rate [29]. However, this technique requires distal dissection of the artery branches, which can increase the risk of bleeding especially in patients with perirenal tissue adhesions and/or short segmental arteries [30,31].…”