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Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine
Sam B Bhayani1, Koon H Rha, Peter A Pinto
1James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
Purpose:
Laparoscopic partial nephrectomy (LPN) has been shown to be a safe and effective option for small renal tumors. However, limited data are available regarding the effect of warm ischemic time on postoperative renal function. We assessed the effect of variable durations of warm ischemia on long-term renal function in patients undergoing LPN.
Materials And Methods:
A total of 118 patients with a single, unilateral, sporadic renal tumor and normal contralateral kidney underwent LPN from August 1998 to November 2002. Patients were divided into 3 groups based on warm ischemic time, namely group 1-no renal occlusion in 42, group 2-warm ischemia less than 30 minutes in 48 and group 3-warm ischemia greater than 30 minutes in 28. All 3 groups were assessed for changes in serum creatinine 6 months after LPN. Additionally, renal remnants were examined with cross-sectional imaging.
Results:
At a median followup of 28 months (range 6 to 56) median creatinine had not statistically increased postoperatively. None of the 118 patients progressed to renal insufficiency or required dialysis after LPN.
Conclusions:
Based on postoperative serum creatinine warm ischemia time up to 55 minutes does not significantly influence long-term renal function after LPN. Thus, during LPN efforts to minimize warm ischemia are important but they should not jeopardize cancer control, hemostasis or collecting system closure.