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

Abstract

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.

Partial nephrectomy for renal tumors using selective parenchymal clamping

“…Given to its good oncological results, in our days PN has become a feasible technique comparable to RN in cancer control, even in cases of renal tumors of 4 cm or larger [8]. The goal of PN is to excise the diseased renal segment without injuring the remaining renal tissue; however, this procedure often involves renal artery occlusion with postoperative ischemic acute renal failure occurring in up to 14% of cases [9] and in up to 20% of patients with a solitary kidney [6,10]. Even more, clamping and unclamping renal artery should be avoided given that it may carry the risk of reperfusion injury [4].…”

“…However, renal-pedicle clamping can lead to ischemia, reperfusion injury and temporal or definite loss of renal function requiring dialysis [4,6,7]. Recently, a technical modification using selective parenchymal clamping has been described [6,7], which allows removing renal tumors without clamping renal pedicle, therefore, avoiding ischemia in the remaining renal tissue.…”

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

“…A self-made clamp with two remodelled malleable retractors 4 and use of Rumel tourniquet have also been reported. 9 More recently open 10 and laparoscopic Satinsky vascular clamps 11 have been used. A Nussbaum clamp was used by Simon et al in 2008 12 in open partial nephrectomy, normally intended for intestinal clamping during general surgery.…”

“…19 Renal cooling with ice was also unnecessary and further reduced the overall operating time. The lower estimated blood loss could be explained by the avoidance of HC, as vascular injury during HC can lead to profuse bleeding 10 or even renal artery dissection.…”

Laparoscopic Partial Nephrectomy – Current State of the Art

“…Several recent human reports suggest that a clamping of the renal parenchyma without hilar clamping is feasible for hemostasis during LPN and open PN [37][38][39][40][41]. A clamp may be used on the parenchyma without dissection of the renal hilum.…”