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

Area of Science:

• Urology
• Surgical Oncology

Background:

• Nephron-sparing surgery (NSS) provides comparable oncological and superior functional outcomes to radical nephrectomy for small renal masses.
• Current NSS techniques, including open, laparoscopic, and robotic approaches, typically employ hilar clamping for hemostasis and tumor excision.
• Zero ischemia techniques were developed to mitigate renal ischemia associated with hilar clamping.

Purpose of the Study:

• To address the lack of standardized terminology in describing zero ischemia and other renal preservation techniques in partial nephrectomy.
• To highlight the variations in reporting functional outcomes after renal surgery.
• To advocate for standardized classifications and guidelines to improve consistency and facilitate critical appraisal.

Main Methods:

• Review of contemporary partial nephrectomy techniques and their descriptions in the literature.
• Analysis of the application and definition of 'zero ischemia' across different surgical approaches.
• Examination of the diversity in reporting functional outcomes post-surgery.

Main Results:

• Significant variability exists in the definition and application of 'zero ischemia' techniques, ranging from no clamping to selective clamping.
• Inconsistent terminology is used to describe various renal preservation strategies.
• Diverse methods are employed for measuring and reporting functional outcomes, hindering comparability.

Conclusions:

• Establishing consensus on terminology for renal preservation techniques and functional outcomes is essential.
• Standardized guidelines will enhance communication, surgical practice, and the critical evaluation of surgical techniques.
• Uniformity in reporting will facilitate better understanding and advancement of nephron-sparing surgery.