A single centre experience of zero-ischaemia laparoscopic partial nephrectomy in Ireland

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Partial nephrectomy is the standard for small renal tumours, offering oncological outcomes similar to radical nephrectomy.
• Hilar vessel clamping during partial nephrectomy can lead to kidney ischaemic damage and long-term renal impairment.
• Minimizing ischaemia is crucial for preserving renal function in nephron-sparing surgery.

Purpose of the Study:

• To evaluate the functional and oncological outcomes of laparoscopic partial nephrectomy (LPN) with zero ischaemia time.
• To assess the impact of avoiding hilar vessel clamping on renal function.
• To determine the safety and efficacy of this technique for small renal tumours.

Main Methods:

• Retrospective review of 43 patients undergoing LPN between 2006 and 2014.
• Utilized thulium laser and LigaSure™ vessel sealing device for tumour resection.
• Preoperative imaging guided anatomical classification; hilar vessels were not clamped in any case.

Main Results:

• Mean tumour diameter was 28.2 mm; 79% of tumours were malignant.
• Zero warm ischaemia time was achieved in all 43 cases.
• No significant difference in pre-operative (73 ml/min/1.73 m²) and post-operative (71 ml/min/1.73 m²) eGFR; one positive surgical margin; no local or distant recurrence during mean 61.6 months follow-up.

Conclusions:

• Zero ischaemia LPN is a safe and oncologically satisfactory procedure for small, localised kidney tumours.
• Avoiding hilar clamping preserves renal function, demonstrating comparable pre- and post-operative estimated glomerular filtration rates.
• This technique represents an effective nephron-sparing approach with excellent long-term oncological control.