Evaluation of renal function under controlled hypotension in zero ischemia robotic assisted partial nephrectomy

Area of Science:

• Urology
• Nephrology
• Surgical Oncology

Background:

• Partial nephrectomy with hilar clamping risks renal function due to ischemia.
• Controlled hypotension is a key component of zero ischemia techniques in partial nephrectomy.
• Minimizing ischemia time is crucial for preserving renal function during partial nephrectomy.

Purpose of the Study:

• To evaluate the impact of hypotensive anesthesia on renal function.
• Assessed effects during and 3 months after robotic assisted partial nephrectomy (RAPN).
• Investigated renal function in patients undergoing zero ischemia RAPN under controlled hypotension.

Main Methods:

• Prospective study of 100 patients (ASA 1-2) undergoing zero ischemia RAPN with controlled hypotension.
• Evaluated serum creatinine, BUN, eGFR, FSE, and 99mTC-MAG-3 renal scintigraphy (ERPF).
• Data collected during surgery and at 3-month follow-up.

Main Results:

• Mean controlled hypotension duration was 50 ± 4 minutes.
• No acute renal failure observed; eGFR varied significantly during and post-surgery.
• Effective renal plasma flow (ERPF) decreased by only 2% at 3 months post-surgery.

Conclusions:

• Controlled hypotension did not detrimentally affect renal function in patients with normal preoperative kidney function.
• Zero ischemia RAPN under controlled hypotension appears safe for renal preservation.
• This technique supports maintaining renal function during and after partial nephrectomy.