Selective renal parenchymal clamping in retroperitoneal partial nephrectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Retroperitoneoscopic partial nephrectomy (RPN) is a standard procedure for renal tumors.
• Hilar occlusion is often used to minimize blood loss but can lead to warm ischemia.
• Selective regional ischemia techniques are being explored to overcome these limitations.

Observation:

• A novel technique using a laparoscopic clamp applied directly to the renal parenchyma, 1 cm below the resection line, was employed during retroperitoneoscopic partial nephrectomy (RPN).
• This method aimed to induce selective regional ischemia, interrupting tumor blood supply while preserving perfusion to the remaining kidney.
• The procedure was performed on a patient with a solitary kidney due to contralateral renal atrophy.

Findings:

• The laparoscopic clamp successfully created a bloodless operative field, allowing for tumor removal without warm ischemia.
• Renal hilar clamping was avoided, resulting in minimal estimated blood loss and no perioperative complications.
• Postoperative radioisotope absorption indicated well-maintained kidney function, with only marginal changes at the enucleated site.

Implications:

• Regional renal parenchymal clamping is a safe and effective alternative to hilar occlusion in RPN.
• This technique enhances maximal nephron-sparing surgery, particularly beneficial for patients with solitary kidneys.
• It offers a method to achieve a bloodless field without the risks associated with warm ischemia.