Korean J Urol.  2007 Sep;48(9):897-902. 10.4111/kju.2007.48.9.897.

The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome

• Bang JK
• Song CR
• Hong BS
• Park HK
• Kim CS
• Ahn HJ

• KMID: 2061288
• DOI: http://doi.org/10.4111/kju.2007.48.9.897

Abstract

PURPOSE
We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping.
MATERIALS AND METHODS
Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning.
RESULTS
Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006).
CONCLUSIONS
Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.

Keyword

Laparoscopy; Nephrectomy; Kidney neoplasms

MeSH Terms

Carcinoma, Renal Cell
Constriction*
Creatinine
Filtration
Humans
Kidney Neoplasms
Laparoscopy
Nephrectomy*
Renal Artery
Veins
Warm Ischemia
Creatinine

Reference

1. Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol. 2002. 167:469–476.

2. Guillonneau B, Bermudez H, Gholami S, El Fettouh H, Gupta R, Adorno Rosa J, et al. Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol. 2003. 169:483–486.

3. Wolf JS, Seifman BD, Montie JE. Nephron sparing surgery for suspected malignancy: open surgery compared to laparoscopy with selective use of hand assistance. J Urol. 2000. 163:1659–1664.

4. Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol. 2003. 170:64–68.

5. Shekarriz B, Shah G, Upadhyay J. Impact of temporary hilar clamping during laparoscopic partial nephrectomy on postoperative renal function: a prospective study. J Urol. 2004. 172:54–57.

6. Ward JP. Determination of the optimum temperature for regional renal hypothermia during temporary renal ischaemia. Br J Urol. 1975. 47:17–24.

7. Novick AC. Renal hypothermia: in vivo and ex vivo. Urol Clin North Am. 1983. 10:637–644.

8. Kobayashi Y, Usui Y, Shima M, Akio H, Miyakita H, Inatsuchi H, et al. Evaulation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using ^99mtechnetium-mercaptoacetyltriglycine. Int J Urol. 2006. 13:1371–1374.

9. Bhayani SB, Rha KH, Pinto PA, Ong AM, Allaf ME, Trock BJ, et al. Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol. 2004. 172:1264–1266.

10. Kondo T, Nakazawa H, Ito F, Onitsuka S, Ryoji O, Yago R, et al. Impact of arterial occlusion during partial nephrectomy on residual renal function: an evaluation with ^99mtechnetium-dimercaptosuccinic acid scintigraphy. Int J Urol. 2002. 9:435–440.

11. Moinzadeh A, Gill IS, Finelli A, Kaouk J, Desai M. Laparoscopic partial nephrectomy: 3-year followup. J Urol. 2006. 175:459–462.

12. Singh D, Rubenstein M, Gill IS. Laparoscopic partial nephrectomy. J Endourol. 2005. 19:451–455.

13. Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol. 2005. 173:42–47.

14. Gill IS, Ramani AP, Spaliviero M, Xu M, Finelli A, Kaouk JH, et al. Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. Urology. 2005. 65:463–466.

15. Haber GP, Gill IS. Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur Urol. 2006. 49:660–665.

16. Venkatesh R, Weld K, Ames CD, Figenshau SR, Sundaram CP, Andriole GL, et al. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology. 2006. 67:1169–1174.