Korean J Urol.  2007 Mar;48(3):265-269. 10.4111/kju.2007.48.3.265.

Partial Nephrectomy using Parenchymal Compression without Renal Pedicle Clamping

• Joung JY
• Jeong IG
• Han KS
• Yang SO
• Jo YJ
• Seo HK
• Chung J
• Park WS
• Lee KH

• KMID: 1997123
• DOI: http://doi.org/10.4111/kju.2007.48.3.265

Abstract

PURPOSE
The hemostasis and closure of the collecting system are still problems to be overcome during a partial nephrectomy. Herein, our initial experience of a parenchymal compression technique, without clamping of the renal pedicle during an open partial nephrectomy, is reported.
MATERIALS AND METHODS
Between May 2000 and August 2005, 10 patients underwent an open partial nephrectomy, without pedicle clamping, for a renal mass. The open partial nephrectomy was performed under regional ischemia, which was achieved by parenchymal compression using a long curved vascular clamp. Several parameters were retrospectively assessed, including the tumor size, location, pathology, estimated blood loss, preoperative and postoperative serum creatinine, complications, and tumor recurrence.
RESULTS
The mean mass size was 23.8mm, ranging between 12 and 55mm, and the tumors were located in the upper, mid and lower poles in 2, 3 and 4 cases, respectively. Pathological examinations revealed renal cell carcinomas in 6, an angiomyolipoma in 1, and complicated renal cysts in 3 patients. In all the patients with renal cell carcinoma, the frozen and permanent sections analyses confirmed negative margins. There were no differences between the preoperative and postoperative creatinine levels, with no significant complications observed, including urinary leak and bleeding, during the recovery period. No patient developed a local recurrence or distant metastasis during the mean follow-up period of 17.2 months.
CONCLUSIONS
This technique is simple, and can be easily practiced by any urological surgeon, without concerns relating to the ischemic time and complications. It is suggested that the regional parenchymal compression is an efficient technique for hemostasis and repair of the collecting system during an open partial nephrectomy.

Keyword

Nephrectomy; Kidney neoplasms; Ischemia

MeSH Terms

Angiomyolipoma
Carcinoma, Renal Cell
Constriction*
Creatinine
Follow-Up Studies
Hemorrhage
Hemostasis
Humans
Ischemia
Kidney Neoplasms
Neoplasm Metastasis
Nephrectomy*
Pathology
Recurrence
Retrospective Studies
Creatinine

Figure

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  Fig. 1 Selective renal parenchymal clamping circumscribing the tumor, using a long curved vascular clamp. The clamping pressure was controlled, using a vessel loop tied with a Mosquito clamp to avoid crushing the kidney.

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  Fig. 2 Contour bulging mass on the lower pole of the left solitary kidney. (A) MRI, (B) renal mass covered with fatty tissue, (C) and (D) parenchymal compression using a vascular clamp and pedicle was not dissected.

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