Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes

Abstract

Background: Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy (PN). The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.

Objective: To evaluate the feasibility and efficiency of laparoscopic PN (LPN) with segmental renal artery clamping in comparison with the conventional technique.

Design, setting, and participants: A total of 75 patients underwent LPN from June 2007 to November 2009. All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney. Thirty-seven patients underwent surgeries with main renal artery clamping, and 38 underwent surgeries with segmental artery clamping.

Intervention: All procedures were performed by the same laparoscopic surgeon.

Measurements: Blood loss, operation time, warm ischemia (WI) time, and complications affected renal function before and after operation were recorded.

Results and limitations: All LPNs were completed without conversion to open surgery or nephrectomy. The novel technique slightly increased WI time (p<0.001) and intraoperative blood loss (p=0.006), while it provided better postoperative affected renal function (p<0.001) compared with the conventional technique. The total complication rate was 12%. Among the 38 cases where segmental renal artery clamping was performed, 7 had to convert to the conventional method. Tumor size and location influenced the number of clamped segmental arteries. Long-term postoperative renal function is still awaited.

Conclusions: LPN with segmental artery clamping is safe and feasible in clinical practice. It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.