Abstract
Purpose
To evaluate the technical feasibility, safety and functional outcomes of zero ischaemia laparoscopic and robotic partial nephrectomy with controlled hypotension for renal tumours larger than 4 cm.
Methods
We evaluated 121 consecutive patients with American Society of Anaesthesiologists (ASA) scores 1–2 who underwent laparoscopic (n = 70) or robotic (n = 51) partial nephrectomy with controlled hypotension with either tumour size ≤4 cm (group 1, n = 78) or tumour size >4 cm (group 2, n = 43) performed by a single surgeon from December 2010 to December 2011. Operative data, complications, serum creatinine, estimated glomerular filtration rates and effective renal plasma flow calculated from 99mTc-mercaptoacetyltriglycine renal scintigraphy were compared. Differences between groups were evaluated by the Chi-square test and the Student’s t test.
Results
A significant difference in mean intraoperative blood loss and postoperative complications was found between the two groups: 168 ml (range: 10–600 ml in group 1) and 205 ml (range: 90–700 ml in group 2); p = 0.005, and 6.4 % versus 18.6 %; p = 0.004, respectively. The mean percentage decrease of ERPF of the operated kidney was 1.8 % in group 1 and 4.1 % in group 2.
Conclusions
Laparoscopic and robotic partial nephrectomy with controlled hypotension for tumours >4 cm in ASA 1–2 patients was feasible with significant higher intraoperative blood loss and postoperative complications compared to smaller renal masses. The benefits of avoiding hilar clamping to preserve kidney function seem excellent.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Simmons MN, Weight CJ, Gill IS (2009) Laparoscopic radical versus partial nephrectomy for tumour >4 cm: intermediate-term oncologic and functional outcomes. Urology 73:1077–1082
Simmons MN, Chreiber MG, Gill IS (2008) Surgical renal ischemia: a contemporaney overview. J Urol 189:19–30
Ng CK, Gill IS, Patil MB et al (2012) Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol 61(1):67–74
Papalia R, Simone G, Ferriero M et al (2012) Laparoscopic and robotic partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping: feasibility, safety and perioperative functional outcomes. J Urol 187(4):1190–1194
Simmons MN, Chung BI, Gill IS (2009) Perioperative efficacy of laparoscopic partial nephrectomy for tumours larger than 4 cm. Eur Urol 55(1):199–207
Pahernik S, Roos F, Rohrig B, Wiesner C, Thuroff JW (2008) Elective nephron-sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 179:71–74
Simone G, Papalia R, Guaglianone S, Forestiere E, Gallucci M (2009) Preoperative superselective transarterial embolization in laparoscopic partial nephrectomy: technique, oncologic, and functional outcomes. J Endourol 23(9):1473–1478
Simone G, Papalia R, Guaglianone S et al (2011) Zero ischemia laparoscopic partial nephrectomy after superselective transarterial tumor embolization for tumours with moderate nephrometry score: long-term results of a single-center experience. J Endourol 25(9):1443–1446
Simone G, Papalia R, Guaglianone S, Gallucci M (2011) Zero ischemia, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int. doi:10.1111/j.1464-410X.2011.10782.x
Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740
Lane BR, Russo P, Uzzo RG et al (2011) Comparison of warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J Urol 185:421–427
Thompson RH, Lane BR, Lohse CM et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58:340–345
Sartcaoglu F, Celiker V, Basgul E et al (2005) The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol 22:157–159
Voldby B, Enevoldsen EM, Jensen FT et al (1985) Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 62:59–67
Choi WS, Samman N (2008) Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 37:687–703
Ramani AP, Desai MM, Steinberg AP et al (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173:42–47
Brodsky SV, Yamamoto T, Tada T et al (2002) Endothelial disfunction in ischemic acute renal failure: rescue by transpanted endothelial cells. Am J Physiol Renal Physiol 282:1140–1149
Conflict of interest
The authors have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Papalia, R., Simone, G., Ferriero, M. et al. Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes. World J Urol 30, 671–676 (2012). https://doi.org/10.1007/s00345-012-0961-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-0961-7