Simplified zero ischemia in robot assisted partial nephrectomy: initial yonsei experience.

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) is a standard procedure for renal tumors.
• Achieving zero ischemia is crucial to preserve renal function.
• Complex renal hilar tumors present unique surgical challenges.

Purpose of the Study:

• To evaluate the safety and feasibility of a simplified zero ischemia technique for RAPN.
• To assess the utility of kidney donor computed tomographic (CT) angiography and conventional laparoscopic bulldog clamps in this technique.

Main Methods:

• A review of seven RAPNs performed using a simplified zero ischemia protocol.
• Selective clamping of tertiary arterial branches supplying the tumor based on 3D CT angiography reconstruction.
• Use of conventional laparoscopic bulldog clamps for vascular control.

Main Results:

• Successful RAPN for seven complex renal hilar tumors.
• No significant differences in operation time, blood loss, or postoperative outcomes compared to standard RAPN.
• All cases achieved negative surgical margins.

Conclusions:

• A simplified zero ischemia technique using kidney donor CT angiography and bulldog clamps is safe and feasible for complex renal hilar tumors.
• This modified technique is easily adoptable for surgeons performing RAPN.
• The approach effectively preserves renal function during complex partial nephrectomies.