Optimizing selective renal clamping in nephron-sparing surgery using the Nussbaum clamp

Selective clamping techniques are an attractive surgical option in nephron-sparing surgery. We describe the use of the Nussbaum clamp for this procedure and point out the advantages of this clamping technique.

The perirenal fat overlying the tumor is removed from the kidney. It is unnecessary to expose the renal artery and vein. The Nussbaum clamp is placed around the tumor 1 to 2 cm proximal to the line of resection. Afterward, the tumor is excised and a hemostasis achieved. Twelve patients underwent nephron-sparing surgery that used the Nussbaum clamp between January 2006 and November 2006. The indications for nephron-sparing surgery were complicated renal cysts or a suspected renal carcinoma in 3 and 9 patients, respectively. The location of the tumor was in the upper pole, lower pole, middle portion, and in a horseshoe-shaped kidney in 4, 6, 1, and 1 patient, respectively. The median time of selective clamping and intraoperative blood loss was 19 minutes (range 12 to 31 minutes) and 300 mL (range: 100 to 500 mL), respectively.

The Nussbaum clamp is a commercially available, easy-to-use and effective instrument for selective clamping in nephron-sparing surgery.