NEPHRON SPARING SURGERY WITHOUT RENAL HILAR CLAMPING

Česká verzia

Authors: E. R. Taylor; A. D. Benson; B. F. Schwartz
Published in the journal: Urol List 2011; 9(4): 12-15

Summary

Introduction:
With the increased use of radiographic imaging, detection of incidental renal lesions has climbed. Most of these lesions are small, < 7 cm, sized lesions. During robotic or laparoscopic nephron sparing surgery renal hilar clamping is often employed. Unfortunately, there is no simple technique to cool renal parenchyma during laparoscopic nephron sparing surgery and studies have shown that longer warm ischemia times are associated with long-term renal damage.

Purpose:
To analyze operative outcomes of patients undergoing laparoscopic and robotic partial nephrectomies without the use of hilar clamping.

Methods:
A retrospective database of patients undergoing partial nephrectomy from 2003 to 2010 was reviewed. Small incidentally discovered renal masses suspicious for malignancy were excised by either conventional laparoscopic partial nephrectomy (LPN) or robotic-assisted laparoscopic partial nephrectomy (RALPN) without renal vessel clamping. Data from these clinical interactions was retrospectively collected and analyzed, which included patient age, pathologic diagnosis, operative time, surgical margins, pre- and post-operative serum creatinine, blood loss, post-operative hemoglobin change, transfusion rate, length of hospital stay, length of follow up, recurrences, and complications.

Results:
Twenty-nine patients underwent partial nephrectomy without renal hilar clamping at our institution. Fifteen were performed by LPN while 14 underwent RALPN. No intra-operative complications occurred and 6 (20%) post-operative complications occurred without the need for reoperation. The average pre- and post-operative serum creatinine levels were 1.2 and 1.1. The average post-operative hemoglobin change was -2.7 (g/dL), with 3 (10.3%) patients requiring a blood transfusion. Of the masses, 72.4% were malignant and the mean renal mass size was 2.2 cm. One positive surgical margin occurred, but at a median follow up of 34 months there have been no recurrences.

Conclusions:
Laparoscopic partial nephrectomy with or without robotic assistance can be safely performed without hilar clamping in select patients providing renal functional protection.

Key words:
renal malss, robotic surgery, partial nephrectomy

Zdroje

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