Nephron Sparing Surgery for Renal Cell Carcinoma Using Selective Renal Parenchymal Clamping

Méjean, Arnaud; Vogt, B; Cazin, Sébastien; Balian, C.; Poisson, Jean François; Dufour, B

doi:10.1016/s0022-5347(05)65421-3

Cited by 28 publications

(9 citation statements)

References 5 publications

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“…In complete renal ischaemia techniques, direct access to the renal artery and vein is necessary [11]. Usually, this is a time‐consuming and potentially dangerous procedure [21]. However, the major concern in this context is the duration of renal ischaemia after hilar clamping.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp

et al. 2009

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OBJECTIVE To report a laparoscopic device that facilitates regional ischaemia in laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS Mimicking the shape of a clamp successfully applied in open PN, we developed a laparoscopic device that allows selective clamping in LPN. After obtaining transperitoneal access to the renal mass, the laparoscopic clamp was placed around the tumour 1–2 cm proximal to the line of resection. After excising the tumour, haemostasis was mainly achieved by applying a haemostyptic agent. RESULTS Three patients with elective indications had LPN using this novel laparoscopic clamp. The tumours were in the upper and lower pole of the kidney in one and two patients, respectively. The tumour diameter was 2.4, 2.6 and 3.2 cm, and the selective clamping time 23, 27 and 38 min. Blood loss was minimal in all three cases, with no complications after LPN. The final pathology showed a papillary and clear cell renal carcinoma in two and one patients, respectively. There were no positive margins on histological assessment. CONCLUSION LPN with clamping of the renal parenchyma using this novel device can be used in selected patients with peripheral tumours. Resection of the tumour in a bloodless field is possible. The main advantage is that ischaemia occurs only in the renal parenchyma next to the tumour, facilitating nephron‐sparing surgery without being pressed for time.

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Section: Discussionmentioning

confidence: 99%

“…[6], or the clamp pressure was maintained via a surgical loop tied with Kocher forceps as described by Mejan et al. [21] using a curved DeBakey aortic clamp. However, in the first technique it seems impossible to maintain a constant pressure [11].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp

et al. 2009

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“…However, these techniques were essentially useful for small polar lesions and not applicable for central tumours. Recently, Mejean et al [18] described a new technique that uses one large aortic DeBakey clamp to surround the tumour and control the bleeding during resection. This technique is similar to the present, but they used a surgical loop around the clamp, tied by Kocher forceps, to control clamping pressure during surgery.…”

Section: Discussionmentioning

confidence: 99%

Nephron‐sparing surgery for renal tumours using selective renal parenchymal clamping

Denardi¹,

Borges²,

Silva³

et al. 2005

BJU International

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RESULTSThe mean (range) operative duration was 190 (120-300) min. Only one patient needed a blood transfusion. There were no complications in 13 patients after NSS. The mean (range) hospital stay was 5 (3-12) days. The pathological examination detected malignant tumours in 13 patients, and a microscopic examination showed adequate surgical margins in all. The mean (range) follow-up was 24.5 (4-60) months. No patients required haemodialysis immediately after surgery or later. CONCLUSIONSSelective renal parenchymal clamping is a simple and efficient technical manoeuvre that facilitates NSS without dissection or clamping of the renal pedicle. Time is not limited as the ischaemia is limited to the tissue surrounding the tumour. The operative duration and blood loss are acceptable and the complications similar to those with the conventional technique. The size and position of the tumour could be limiting factors to this technique.

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“…Postoperatively, no blood transfusions were required. Similarly, Mejean et al [18], who used a DeBakey aortic clamp in 10 patients with renal cell carcinoma, reported insignificant intraoperative blood loss with no complications, including urinary flank drainage or renal dysfunction. In the present series of patients using umbilical tape parenchymal compression, benefits consistent with those previously reported were noted when compared with the standard vascular clamping method.…”

Section: Discussionmentioning

confidence: 97%

“…After the initial introduction by Gill et al [6], many other methods have been introduced, including the use of the Reni-Clamp [2], the Satinsky clamp [16], vascular clamps [17], and the large curved DeBakey aortic clamp [18,19]. Gill et al, who used the tourniquet method, similar to the method we use here, reported that because the renal hilum was not occluded, blood flow to the remainder of the kidney was uninterrupted, thus minimizing the chances of ischemic injury to the renal remnant.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Parenchymal Compression in Open Partial Nephrectomies: A Comparison with Conventional Vascular Clamping

Choi

Kang

et al. 2010

Korean J Urol

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Purpose:We evaluated the efficacy of parenchymal compression in open partial nephrectomies (OPNs) compared with that of the conventional vascular clamping method. Materials and Methods: OPNs were conducted by means of the parenchymal compression technique at our institution from April 2006. Among these, the operative outcomes of 20 consecutive patients with normal preoperative renal function (Group 1) were matched with those of 20 control patients from the database of previous operations who underwent OPN with a conventional vascular clamping method (Group 2). Results: All preoperative characteristics were similar in both groups. The operative time was significantly higher for Group 2 (132.4±17.7 vs. 151.4±21.4 minutes, p=0.031). Estimated blood loss was slightly higher for Group 2, with marginal statistical significance (173.7±11.5 vs. 211.2±43.8 ml, p=0.06). Histologic examination revealed that over 80% of the tumors in both groups were renal cell carcinomas. For all patients, the pathology results of specimens were negative. Serum creatinine, checked at 1, 3, and 7 days after the operation, was significantly increased in both groups to a similar degree. However, 30 days after surgery, the patterns of serial serum creatinine levels demonstrated statistically significant differences by repeated-measures ANOVA (p＜0.001), with a trend of more elevated in Group 2 than in Group 1, although values were within the normal range. No major complications occurred in either group. Conclusions: OPN using the parenchymal compression method had acceptable outcomes in terms of complete tumor control, avoiding warm ischemic time, and minimizing blooding, with good preservation of renal function and minimal complications.

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Nephron Sparing Surgery for Renal Cell Carcinoma Using Selective Renal Parenchymal Clamping

Abstract: Selective renal parenchymal clamping is a simple and efficient technical maneuver for facilitating nephron sparing surgery without pedicle dissection and clamping for renal peripheral or pole tumors. Neoplasm location and size are the limiting factors of this technique.

Cited by 28 publications

References 5 publications

Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp

Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp

Nephron‐sparing surgery for renal tumours using selective renal parenchymal clamping

Efficacy of Parenchymal Compression in Open Partial Nephrectomies: A Comparison with Conventional Vascular Clamping

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