Related Experiment Video
Updated: Apr 16, 2026
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Selective Versus Hilar Clamping During Minimally Invasive Partial Nephrectomy: A Systematic Review and Meta-Analysis
Liang Zhou1, Xin Wei1, Wen-Jin Sun2
11 Department of Urology, West China Hospital, Sichuan University , Chengdu, Sichuan, P.R. China .
Purpose:
To compare the clinical efficacy and safety of selective vs hilar clamping during minimally invasive partial nephrectomy (PN).
Methods:
Studies comparing the effect and safety of selective versus hilar clamping during PN were identified by a systematic search using MEDLINE and EMBASE from January 2000 to November 2014. Quality of the selected studies was assessed according to the Newcastle-Ottawa Scale (NOS).
Results:
A total of seven retrospective studies were included. No significant differences were observed between the two groups in age, body mass index, tumor size, pre-estimated glomerular filtration rate (eGFR), operative time, and length of stay. The selective clamping group had greater estimated blood loss (P<0.01) but similar blood transfusion rate (P=0.78) compared with the hilar clamping group. There were no significant differences between the two groups in terms of urinary leaks, overall complication rate, and positive margin rate. Patients who underwent selective clamping had a lower change in eGFR (mean difference [MD]: 13.95; 95% CI 8.85 to 19.05; P<0.01) and a lower percent change in eGFR (MD: 18.51; 95% CI 14.18 to 22.84; P<0.01) at 1 week. Combined results from two studies showed a trend toward a lower percent change in eGFR at 3 months (MD: 5.47; 95% CI -0.28 to 11.22; P=0.06). At 6 months, two studies showed no significant differences in percent change of renal function between the two groups (MD: 16.85; 95% CI -10.47 to 44.16; P=0.23).
Conclusions:
Although selective clamping resulted in greater estimated blood loss, it provided comparable perioperative safety and superior short-term renal function preservation. The advantage of selective clamping in preservation of intermediate-term renal function remains to be evaluated in the future, however. There is a need for properly designed studies to confirm our founding.
Insights
Selective clamping during minimally invasive partial nephrectomy offers comparable safety and better short-term kidney function preservation than hilar clamping. Further research is needed to confirm long-term benefits.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Minimally invasive partial nephrectomy (PN) is a standard treatment for renal tumors.
- Clamping techniques, including selective and hilar clamping, aim to minimize renal ischemia during PN.
- The optimal clamping strategy for preserving renal function remains under investigation.
Purpose of the Study:
- To compare the clinical efficacy and safety of selective versus hilar clamping during minimally invasive partial nephrectomy (PN).
Main Methods:
- A systematic literature search was conducted using MEDLINE and EMBASE (January 2000 - November 2014).
- Seven retrospective studies comparing selective and hilar clamping during PN were included.
- Study quality was assessed using the Newcastle-Ottawa Scale (NOS).
Main Results:
- No significant differences were found in patient demographics, tumor size, or operative time between groups.
- Selective clamping was associated with greater estimated blood loss but similar transfusion rates.
- Both techniques showed comparable urinary leak, overall complication, and positive margin rates.
- Selective clamping demonstrated superior short-term preservation of estimated glomerular filtration rate (eGFR) at 1 week.
- Trends suggested potential intermediate-term renal function preservation, though not statistically significant at 3 or 6 months.
Conclusions:
- Selective clamping provides comparable perioperative safety and superior short-term renal function preservation compared to hilar clamping.
- While selective clamping shows promise for intermediate-term renal function, further evaluation is required.
- Well-designed prospective studies are needed to confirm these findings and establish definitive recommendations.
