Laparoscopic partial nephrectomy with "on-demand" clamping reduces warm ischemia time

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic partial nephrectomy (LPN) is a standard treatment for renal tumors.
• Minimizing warm ischemia time (WIT) is crucial for preserving renal function during LPN.
• Traditional LPN often involves prolonged renal pedicle clamping, increasing WIT.

Purpose of the Study:

• To evaluate the impact of an "on-demand" extracorporeal clamping strategy on WIT during LPN.
• To assess the feasibility and outcomes of this modified clamping technique.

Main Methods:

• Retrospective review of 39 patients undergoing transperitoneal LPN for renal tumors.
• Early hilar dissection with extracorporeal clamping, with pedicle clamping reserved for excessive bleeding.
• Immediate release of clamp upon renal defect closure with sutures and hemostatic agents.

Main Results:

• Renal pedicle clamping was required in 31 of 39 patients.
• The median WIT in patients requiring clamping was 9 minutes.
• Median operative time was 120 minutes, with low blood loss (150 ml) and minimal positive margins (1 case).

Conclusions:

• "On-demand" extracorporeal clamping significantly decreases WIT during LPN.
• This technique is feasible and allows for potentially shorter ischemia times compared to standard methods.
• The study highlights the benefits of selective pedicle clamping in selected LPN cases.