Promising early results after hand-assisted laparoscopic partial nephrectomy in carefully selected patients

The incidence of the diagnosis of renal cell carcinoma has increased during the past two decades. Kidney damage occurring beyond 30 min of warm ischaemia is significant and mostly irreversible, even in completely normal renal systems. The aim of this study was to evaluate the role and safety of early removal of renal artery clamps and its influence on warm ischaemia time and renal function.

Data from 15 patients who underwent hand-assisted laparoscopic partial nephrectomy (HALPN) were collected retrospectively. The operative method was as follows. The kidney was dissected using hand-assisted laparoscopic technique, the gerotic fascia was dissected and a complete exploration of the kidney was achieved. A vascular bulldog clamp was removed from the renal artery immediately after the tumour resection bed had been closed with a running suture with Hem-o-Lok clips at either end.

The size of tumours ranged between 2 cm and 7 cm. The mean warm ischaemia time was 11.2 min. The mean estimated glomerular filtration rate had decreased by 7.8 ml/min/1.73 m(2) metres (11%) six months after the operation. The estimated blood loss was less than 200 ml. The mean operating time was 119 min and the mean postoperative hospital stay was 3.2 days. There was no need for postoperative blood transfusions, and neither delayed bleeding nor urinary leakage occurred.

Early removal of renal artery clamps during HALPN is associated with a considerable decrease in warm ischaemia time and renal function preservation and pre- and postoperative outcomes are acceptable.

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