ZERO ISCHEMIA FOR PARTIAL NEPHRECTOMY: A SAFE PROCEDURE FOR THE MANAGMENT OF SMALL KIDNEY TUMORS
Robotic partial nefrectomy (RPN) and laparoscopic partial nefrectomy ( LPN) are effective surgical treatments for small kidney tumors ( T1a– T1b) (1).
The aim of this retrospective study is to evaluate the effectivness of zero ischemia techinique in RPN and LPN for small renal masses.
Materials and Methods
We retrospectively evaluated 296 renal tumorectomy performed in our istitution. (198 LPN and 98 RPN).
We performed in all cases renal tumor enucleation. Tumor average size was 4,1 cm (7,2-1,2) and R.E.N.A.L. average score 5.1 (4-8).
The main outcome parameters examined were intraoperative blood loss, intraoperative and post-operative blood trasfusions and surgical conversion rate.
All the RPN procedures were concluded without conversion to open surgery but 1 (1.05%). We performed RPN with clamp of renal artery in 3 caes (1,1 %) with R.E.N.A.L score 7 and 8 . 5 LPN (all with R.E.N.A.L score 7) were converted to open procedure (2.5%).
94 RPN and all the LPN were performed without vascular approach.
Intraoperative transfusion never occours in these series. Itraoperative average blood loss was 110 cc (10-260 cc) in RPN and 245 cc in LPN (20-460cc).
3 (1.1%) patients underwent to RPN and 15 (5%) after LPN were postoperatively trasfsused.
In our experience most of LPN and RPN procedures were performed without clamping . Only three RPN procedures were performed with vascular approach and hilar clamping
Small renal masses with R.E.N.A.L score ≤ 6 enucleation can be performed without hilar clamping. Pedicle dissection can be safely avoided in these cases to reduce operative time and the consequent related risks.
1 Curr Opin Urol. 2013 Sep;23(5):399-402. doi: 10.1097/MOU.0b013e3283632115.
Hilar clamping versus off-clamp laparoscopic partial nephrectomy for T1b tumors.
Kreshover JE1, Kavoussi LR, Richstone L.