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Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function
Jeffrey Campbell1, Garson Chan1, Patrick P Luke1
1Schulich School of Medicine and Dentistry and Department of Surgery, Division of Urology, Western University, London, ON, Canada.
Summary
Early clamp release (ECR) during partial nephrectomy (PN) significantly reduces warm ischemic time (WIT). This technique preserves ipsilateral renal function without increasing complications or bleeding risk.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Intraoperative warm ischemic time (WIT) during partial nephrectomy (PN) is a modifiable risk factor for renal dysfunction.
- Hilar clamping is a common cause of WIT in PN.
Purpose of the Study:
- To assess early clamp release (ECR) as a strategy to reduce WIT.
- To evaluate the impact of ECR on renal function and bleeding during minimally invasive PN.
Main Methods:
- Retrospective analysis of 70 patients undergoing minimally invasive PN.
- Comparison between standard technique and ECR modification.
- Assessment of WIT, complications, estimated glomerular filtration rate (eGFR), and differential renal function (MAG-3 renography).
Main Results:
- ECR group had significantly lower WIT (18.8 vs. 31.5 minutes).
- No significant difference in overall eGFR change, but ECR showed less ipsilateral renal function loss (4% vs. 9%).
- Similar blood loss and complication rates between ECR and control groups.
Conclusions:
- ECR is a safe and reproducible technique to reduce WIT in laparoscopic PN.
- ECR reduces ipsilateral renal dysfunction without increasing operative risks.
- ECR is a valuable alternative for preserving renal function during PN.
