Korean J Urol.  2010 Jan;51(1):8-14.

Efficacy of Parenchymal Compression in Open Partial Nephrectomies: A Comparison with Conventional Vascular Clamping

• Ko YH
• Choi H
• Kang SG
• Kang SH
• Park HS
• Cheon J
• Lee JG
• Kim JJ
• Yoon DK

Abstract

PURPOSE
We evaluated the efficacy of parenchymal compression in open partial nephrectomies (OPNs) compared with that of the conventional vascular clamping method. MATERIALS AND METHODS: OPNs were conducted by means of the parenchymal compression technique at our institution from April 2006. Among these, the operative outcomes of 20 consecutive patients with normal preoperative renal function (Group 1) were matched with those of 20 control patients from the database of previous operations who underwent OPN with a conventional vascular clamping method (Group 2). RESULTS: All preoperative characteristics were similar in both groups. The operative time was significantly higher for Group 2 (132.4+/-17.7 vs. 151.4+/-21.4 minutes, p=0.031). Estimated blood loss was slightly higher for Group 2, with marginal statistical significance (173.7+/-11.5 vs. 211.2+/-43.8 ml, p=0.06). Histologic examination revealed that over 80% of the tumors in both groups were renal cell carcinomas. For all patients, the pathology results of specimens were negative. Serum creatinine, checked at 1, 3, and 7 days after the operation, was significantly increased in both groups to a similar degree. However, 30 days after surgery, the patterns of serial serum creatinine levels demonstrated statistically significant differences by repeated-measures ANOVA (p<0.001), with a trend of more elevated in Group 2 than in Group 1, although values were within the normal range. No major complications occurred in either group. CONCLUSIONS: OPN using the parenchymal compression method had acceptable outcomes in terms of complete tumor control, avoiding warm ischemic time, and minimizing blooding, with good preservation of renal function and minimal complications.

Keyword

Kidney neoplasms; Organ preservation; Nephrectomy

MeSH Terms

Carcinoma, Renal Cell
Constriction
Creatinine
Humans
Kidney Neoplasms
Nephrectomy
Operative Time
Organ Preservation
Reference Values
Warm Ischemia
Creatinine

Figure

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  FIG. 1 The modified renal parenchymal compression method using umbilical tape. The renal parenchyma was surrounded selectively with the umbilical tape, which was generally placed 2-3 cm from the tumor to allow for an excision with adequate surgical margins and was then compressed with a Mosquito clamp. To safeguard against inadvertent slippage of the umbilical tape, the line of renal parenchymal resection was 2 cm distal to the edge of the umbilical tape.

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  FIG. 2 Serial changes in serum creatinine in the two groups during the surgical hospitalization and follow-up periods. a: significant increase in the postoperative serum creatinine level compared with the preoperative level in the vascular clamping group (Group 2), by Mann-Whitney U test, b: significant increase in the postoperative serum creatinine level compared with the preoperative level in the parenchymal compression group (Group 1), by Mann-Whitney U test.

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