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Related Experiment Video

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Laparoscopic partial nephrectomy without clamping the renal pedicle.

Alexandre Stievano Carlos1,2, Igor Nunes-Silva3, Hamilton de Campos Zampolli4

  • 1ABC Medical School, Santo André, SP, Brazil. ale_carlos@uol.com.br.

Surgical Endoscopy
|August 30, 2019
PubMed
Summary

Laparoscopic partial nephrectomy without renal pedicle clamping (LPNWRPC) offers comparable oncological outcomes and safety to LPN with clamping (LPNRPC). LPNWRPC preserves renal function, as evidenced by better postoperative creatinine levels and glomerular filtration rates.

Keywords:
Hot ischemiaLaparoscopyNephrectomyRenal neoplasms

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Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Renal cell carcinoma (RCC) is a significant renal neoplasm, with surgical resection being the primary curative treatment.
  • Laparoscopic partial nephrectomy (LPN) has become a standard, safe, and reproducible surgical approach since the 1990s.
  • LPN without renal pedicle clamping (LPNWRPC) has emerged as a technique to potentially improve postoperative renal function while maintaining minimally invasive benefits.

Purpose of the Study:

  • To compare perioperative, oncological, and functional outcomes of LPN with renal pedicle clamping (LPNRPC) versus LPNWRPC.
  • To evaluate the impact of renal pedicle clamping on postoperative renal function and complications in patients undergoing LPN.

Main Methods:

  • Retrospective analysis of 177 patients who underwent LPN for renal neoplasms between January 2000 and January 2016.
  • Patients were divided into two groups: LPNRPC (n=88) and LPNWRPC (n=89).
  • Comparison of surgical margins, postoperative complications (Clavien 3-4), creatinine levels, and estimated glomerular filtration rate (eGFR).

Main Results:

  • No significant difference in positive surgical margins or major postoperative complications between LPNRPC and LPNWRPC groups.
  • Patients in the LPNRPC group showed significantly higher postoperative creatinine levels (p=0.031) and a worsened eGFR (p=0.017).
  • While bleeding and surgical time were higher in the LPNWRPC group, there was no increased need for blood transfusions or serious complications.

Conclusions:

  • LPNWRPC is an effective, safe, and feasible alternative to LPNRPC, with comparable oncological results and low complication rates.
  • LPNWRPC demonstrates a significant advantage in preserving postoperative renal function, indicated by better creatinine levels and eGFR.
  • Warm ischemia time (WIT) is a key factor in long-term renal dysfunction; LPNWRPC eliminates WIT, potentially mitigating this impact.