Selective renal parenchymal clamping in robotic partial nephrectomy: initial experience.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Minimally invasive partial nephrectomy often requires renal hilar clamping for a bloodless field, potentially causing renal damage.
• Selective regional ischemia aims to mitigate risks associated with complete renal ischemia.

Purpose of the Study:

• To evaluate the early experience of using a laparoscopic clamp for selective regional ischemia during robotic-assisted partial nephrectomy.
• To assess the safety and efficacy of this technique in creating a bloodless operative field without hilar occlusion.

Main Methods:

• A laparoscopic clamp was applied to the renal parenchyma, 2-3 cm proximal to the tumor resection line, after tumor margin delineation with laparoscopic ultrasound.
• Tumor excision was followed by robotic repair of the renal defect and use of hemostatic agents.

Main Results:

• The procedure was performed on three patients with exophytic renal masses; mean tumor diameter was 4.9 cm.
• Mean selective clamp time was 37 minutes, with minimal blood loss and no need for renal hilar clamping.
• No perioperative complications occurred, and the mean change in creatinine was minimal (0.1).

Conclusions:

• Regional renal parenchymal clamping is a safe and effective method for achieving a bloodless field in select robotic partial nephrectomy cases.
• This technique facilitates frozen pathologic evaluation of tumor and margins without warm ischemia concerns.
• It provides an additional tool for surgeons performing minimally invasive nephron-sparing surgery.