Zero ischaemia partial nephrectomy: a call for standardized nomenclature and functional outcomes

Nephron-sparing surgery for the removal of small renal masses delivers equivalent oncological outcomes and better functional outcomes compared with those associated with radical nephrectomy. All contemporary partial nephrectomy techniques including open, laparoscopic and robotic approaches involve the use of hilar clamping in order to facilitate haemostasis, and to enable accurate tumour excision and parenchymal reconstruction. Zero ischaemia was subsequently introduced as a technique to eliminate the renal ischaemia induced by hilar clamping. Following the introduction of zero ischaemia techniques, researchers have arbitrarily applied this term to techniques ranging from no use of clamping to selective clamping of renal arteries and/or veins, or their branches. Substantial variations exist in the way that zero ischaemia and other renal preservation techniques are described in the literature. Similarly, further diversity exists in the measurement and reporting of functional outcomes after surgery. The introduction of standard and reproducible classifications or guidelines will ensure consistency and uniformity. Establishing consensus on the terminology used to describe techniques and functional outcomes will not only facilitate improved communication and surgical practice, but will also enable critical appraisal of surgical techniques.