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Robot-assisted Partial Splenectomy
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Robot-assisted partial nephrectomy: How to minimise renal ischaemia
Chandran Tanabalan1, Avi Raman1, Faiz Mumtaz1
1Specialist Centre for Renal Cancer, Royal Free Hospital, London, UK.
Arab Journal of Urology
|August 28, 2018
Summary
Minimizing renal ischemia during robot-assisted partial nephrectomy (RAPN) is crucial for preserving kidney function. Keeping warm ischemia time (WIT) under 25 minutes is vital, with specific surgical techniques available for longer procedures.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Renal damage increases with ischaemic time.
- Minimizing renal ischaemia is key for preserving renal function during nephron-sparing surgery (NSS).
- Patients undergoing NSS often have comorbidities like chronic kidney disease, complicating functional recovery prediction.
Purpose of the Study:
- To assess the importance of renal ischaemic times for warm and cold ischaemia.
- To explore surgical techniques for minimizing renal ischaemia in robot-assisted partial nephrectomy (RAPN).
Main Methods:
- Review of current data on safe warm ischaemia time (WIT) and cold ischaemic time.
- Analysis of surgical techniques in RAPN aimed at reducing ischaemia.
Main Results:
- Safe warm ischaemia time (WIT) is generally accepted as ≤25 minutes, and cold ischaemic time as ≤35 minutes.
- Efforts in RAPN should focus on keeping WIT <25 minutes.
- Techniques like parenchymal or segmental artery clamping, early unclamping, or off-clamp methods may be used for prolonged ischaemia but may not improve outcomes.
Conclusions:
- Minimizing ischaemic time is a critical, modifiable factor for preserving renal function in RAPN.
- Careful preoperative planning, consideration of tumour factors, and meticulous surgical technique are essential for optimal outcomes in RAPN.
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