Investig Clin Urol.  2019 Mar;60(2):99-107. 10.4111/icu.2019.60.2.99.

Selective clamping hand-assisted laparoscopic partial nephrectomy for localized renal tumors: A novel technique

• Tae BS
• Jeon BJ
• Kim NC
• Choi H
• Bae JH
• Park JY

• KMID: 2438820
• DOI: http://doi.org/10.4111/icu.2019.60.2.99

Abstract

PURPOSE
In this study, we described our initial experience and analyze the learning curve of segmental renal artery branch clamping with hand-assisted laparoscopic partial nephrectomy (PN) using special instruments.
MATERIALS AND METHODS
We conducted a retrospective review of consecutive cases of hand-assisted laparoscopic PN (LPN) between May 2015 and April 2018. Patient demographics, tumor characteristics, perioperative details, postoperative complications, and warm ischemic time for segmental artery branch clamping were included in our analysis. We used the cumulative sum (CUSUM) method to generate learning curves.
RESULTS
Segmental renal artery branch clamping was successfully completed in 16 of 20 patients. The median tumor size was 2.9 cm (range, 1.7-7.0 cm), median operation time was 185 minutes (range, 140-245 minutes), median blood loss was 291 mL (range, 100-600 mL), and median hospital stay was 5 days (range, 4-7 days). The median selective ischemic time was 21 minutes (range, 16-35 minutes). No patient had postoperative complications, acute or delayed bleeding. The median pre- and postoperative serum creatinine levels (0.91 and 0.98 mg/dL, respectively), and the pre- and postoperative estimated glomerular filtration rate (89.7 and 79.6 mL/min per 1.73 m2, respectively) were similar. Upon visual assessment of the CUSUM plots, a downward inflection point for decreasing total operation time was observed in the 9th case and estimated blood loss in the 12th case.
CONCLUSIONS
Our study shows that segmental renal artery branch clamping hand-assisted LPN for localized renal tumors is feasible, safe, and has a relatively short learning curve.

Keyword

Ischemia; Laparoscopy; Nephrectomy

MeSH Terms

Arteries
Constriction*
Creatinine
Demography
Glomerular Filtration Rate
Hemorrhage
Humans
Ischemia
Laparoscopy
Learning Curve
Length of Stay
Methods
Nephrectomy*
Postoperative Complications
Renal Artery
Retrospective Studies
Warm Ischemia
Creatinine

Figure

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  Fig. 1 Patients positioning and port placement. (A) Right side. (B) Left side.

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  Fig. 2 Intraoperative picture of selective arterial clamping hand-assisted partial nephrectomy. (A) Segmental arteries dissection. (B) Tumor-supplying segmental artery clamped with single-use minibulldog clamps. (C) Tumor devascularization. (D) Fibrin glue on the resection bed. S, segmental artery; P, laparoscopic peanut dissector; B, mini-bulldog clamps; T, renal tumor; F, fibrin glue.

• 

  Fig. 3 (A) CUSUM analysis for EBL in SC-HALPN. (B) CUSUM analysis for total operation time in SC-HALPN. CUSUM, cumulative sum; EBL, estimated blood loss; SC-HALPN, selective clamping hand-assisted laparoscopic partial nephrectomy; OP, operation.

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