A model for assuring clamping success during laparoscopic partial nephrectomy with segmental renal artery clamping

Abstract

Objectives

A model for assuring clamping success was established for laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping (SRAC).

Materials and methods

Patients (n = 107; December 2009–September 2011) who underwent LPN with SRAC dependent on the experience of the surgeon and CTA were retrospectively reviewed to determine the optimal characteristics of target arteries. After multiple logistic regression analysis, variables used to build a nomogram were selected using a backward elimination scheme. A model for a clamping program customized to the patient was designed. The surgical outcomes of patients (n = 141; October 2011–June 2014) who subsequently underwent LPN-SRAC with the applied model were compared with those of the first group of patients.

Results

Five potential predictors were initially assessed: segmental renal artery angle, target artery diameter, and distance (d) to the abdominal aorta, renal hilum (d _RH), and kidney midline (d _KML). The regression equation was set up as:

$${\text{Clamping assurance}} = \frac{{{\text{e}}^{x} }}{{1 + {\text{e}}^{x} }},\quad {\text{where}}\,x = 12.360 + 4.863\left( {d_{\text{RH}} } \right) - 8.848\left( {d_{\text{KML}} } \right).$$

Comparing the patient groups, those for whom the new SRAC model was applied had a significantly better success rate of clamping (P < 0.001), less total operative time (P < 0.001), and less operative blood loss (P = 0.042). No obvious differences were observed in time of warm ischemia, postoperative hospitalization, RENAL nephrometry score, or number of final clamped branches.

Conclusions

The model for assuring clamping success was helpful in designing an SRAC program and thus benefiting the LPN procedure.