PURPOSE: Demonstrate two alternatives that permit a warm ischemia time reduction during laparoscopic partial nephrectomy.
MATERIALS AND METHODS: In this video, two cases of intermediate complexity renal tumors according to the RENAL nephrometry renal scoring system illustrating the techniques and our preliminary experience: a 65 year old man with a 4 cm right, posterior renal tumor. This patient underwent an early unclamping and parenchymal suturing using a greek bar continuous suture with hem-o-lock clips attached to the respective extremities of the suture; The second patient is a 49 year old man with a 3 cm renal tumor. The technique utilized was no clamping resection following the ABC Medical School technique: dissection of renal hilum for eventual clamping if necessary, a frontal 360 degrees visualization of tumor limits, pneumoperitoneum pressure elevated to 25mmHg during tumor resection, spiral excavation of normal parenchyma around the tumor and resection with negative margins.
RESULTS: We previously performed 15 cases utilizing the early unclamping technique. The mean clamp time was 15 minutes with a mean blood loss of 285 mL. Only 1 patient had focal positive surgical margins, without recurrence demonstrated at 30 months. Fifteen partial nephrectomies were previously performed with on demand clamping. In 3 cases, clamping was necessary with a mean ischemia time of 11 minutes. The mean blood loss was 390 mL and 2 cases required a perioperative blood transfusion. One case presented with a positive focal margin without recurrence demonstrated at 24 months of follow-up. Renal function was preserved in all cases regardless of the technique applied.
CONCLUSION: Warm ischemia time can be reduced and kidney function can be preserved during laparoscopic nephrectomy if either early unclamping or on demand clamping are selectively applied.
Written by:
Carlos AS1, Tobias-Machado M, Starling ES, Corrêa de Araujo FB, Faria EF, Nogueira L, Juliano RV, Pompeo AC Are you the author?
1Department of Urology, ABC Medical, Santo Andre, SP, Brazil.
Reference: Int Braz J Urol. 2013 Jan-Feb;39(1):145, discussion 146
doi: 10.1590/S1677-5538.IBJU.2013.01.21
PubMed Abstract
PMID:
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