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Laparoscopic partial nephrectomy without clamping the renal pedicle

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Abstract

Introduction

Renal cell carcinoma (RCC) accounts for about 2–3% of all malignancies in adults and 90–95% of renal neoplasms. Curative treatment is eminently surgical, the first reports describing the laparoscopic partial nephrectomy (LPN) date from the beginning of the 1990s since then LPN has been consolidated as a safe and reproducible procedure. In order to improve the results of the LPN in relation to the postoperative renal function, while retaining the benefits of minimally invasive surgery, some surgeons began to implement the technique of laparoscopic partial nephrectomy without renal pedicle clamping (LPNWRPC) in selected cases.

Objective

To compare the perioperative, oncological and functional results of patients submitted to LPN with renal pedicle clamping (LPNRPC) and LPNWRPC in the hospitals linked to our institution.

Material and method

All patients’ charts were submitted to LPN from January 2000 to January 2016. Data were collected and analyzed retrospectively, patients were divided into two groups: LPNRPC (RPC group) and LPNWRPC (WRPC group).

Results

Data from 177 patients submitted to LPN for renal neoplasms were collected, 88 patients (49.7%) in the RPC group and 89 (50.3%) in the WRPC group. Surgical margins were positive in 2.56% of patients in the RPC group and 3.70% in the WRPC group. There was no significant difference despite the technique applied. Clavien 3 or 4 postoperative complications occurred in five cases (5.68%) in the RPC group and three cases in the WRPC group (3.7%), with no significant difference between the groups. Patients in the RPC group developed higher levels of creatinine in the postoperative period (creatinine 1.01 ± 0.16 preoperative vs. 1.12 ± 0.18 postoperatively, p = 0.031) and worsened filtration rate (EGFR) (preoperative 79.18 ± 16.28 × 74.43 ± 21.06 post-operative, p = 0.017).

Discussion

Our casuistry agrees with the results of previous studies with regard to major bleeding in patients submitted to LPNWRPC when compared to those submitted to LPNWRPC. However, although bleeding and surgical time were higher in the WRPC group, there was no impact on patients’ postoperative evolution regarding both the need for transfusion of blood products and serious complications. In the high-complexity tumors, the mean warm ischemia time (WIT) in the RPC group was higher, this was probably responsible for a better response in the WRPC group evolving patients with lower creatinine levels and better postoperative glomerular filtration rates.

Conclusion

LPNWRPC has been shown to be equally effective, safe, feasible, with low blood transfusion rates and postoperative complications comparable to LPNRPC, and has similar oncological results. Main impact factor in long-term renal dysfunction is WIT, which can be completely eliminated with the use of LPNWRPC.

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References

  1. Hung AJ et al (2013) “Trifecta” in partial nephrectomy. J Urol 189(1):36–42

    Article  PubMed  Google Scholar 

  2. Koo HJ, Lee DH, Kim IY (2010) Renal hilar control during laparoscopic partial nephrectomy: to clamp or not to clamp. J Endourol 24(8):1283–1287

    Article  PubMed  Google Scholar 

  3. Eisenberg MS et al (2011) Innovations in laparoscopic and robotic partial nephrectomy: a novel ‘zero ischemia’ technique. Curr Opin Urol 21(2):93–98

    Article  PubMed  Google Scholar 

  4. Gill IS et al (2012) Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol 187(3):807–814

    Article  PubMed  Google Scholar 

  5. Liu W et al (2014) Off-clamp versus complete hilar control partial nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. J Endourol 28(5):567–576

    Article  CAS  PubMed  Google Scholar 

  6. Kim TS, Oh JH, Rhew HY (2014) “Off-clamp, non-renorrhaphy” laparoscopic partial nephrectomy with perirenal fat and Gerota’s fascia reapproximation: initial experience and perioperative outcomes. J Laparoendosc Adv Surg Tech A 24(5):339–344

    Article  PubMed  Google Scholar 

  7. Campbell SC et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279

    Article  PubMed  Google Scholar 

  8. Nadu A et al (2005) Laparoscopic partial nephrectomy: is it advantageous and safe to clamp the renal artery? Urology 66(2):279–282

    Article  PubMed  Google Scholar 

  9. Winfield HN et al (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7(6):521–526

    Article  CAS  PubMed  Google Scholar 

  10. Chang CM et al (2016) Adjusted age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery. PLoS ONE 11(2):e0148076

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Hafeez AR, Idrees MK, Akhtar SF (2016) Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: comparison with 24 h urine creatinine clearance. Saudi J Kidney Dis Transpl 27(2):320–325

    Article  PubMed  Google Scholar 

  12. Shah PH et al (2016) To clamp or not to clamp? Long-term functional outcomes for elective off-clamp laparoscopic partial nephrectomy. BJU Int 117(2):293–299

    Article  PubMed  Google Scholar 

  13. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853

    Article  PubMed  Google Scholar 

  14. Clavien PA et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  15. Arora S et al (2018) ‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis. BJU Int 121(1):119–123

    Article  CAS  PubMed  Google Scholar 

  16. Carlos AS et al (2013) Alternative techniques to reduce warm ischemia time in laparoscopic partial nephrectomy. Int Braz J Urol 39(1):145 (discussion 146)

    Article  PubMed  Google Scholar 

  17. Thompson RH et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58(3):340–345

    Article  PubMed  Google Scholar 

  18. Gill IS et al (2011) “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 59(1):128–134

    Article  PubMed  Google Scholar 

  19. Guillonneau B et al (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169(2):483–486

    Article  CAS  PubMed  Google Scholar 

  20. George AK et al (2013) Perioperative outcomes of off-clamp vs complete hilar control laparoscopic partial nephrectomy. BJU Int 111(4 Pt B):E235–E241

    Article  PubMed  Google Scholar 

  21. Minervini A, Siena G (2012) ‘Zero ischaemia’, sutureless laparoscopic partial nephrectomy for renal tumours with low nephrometry score. BJU Int 110(1):130

    Article  PubMed  Google Scholar 

  22. Simone G et al (2012) ‘Zero ischaemia’, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int 110(1):124–130

    Article  PubMed  Google Scholar 

  23. Satkunasivam R et al (2015) Robotic unclamped “minimal-margin” partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. Eur Urol 68(4):705–712

    Article  PubMed  Google Scholar 

  24. Rha KH et al (2017) Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety. BJU Int 120(5):682–688

    Article  PubMed  Google Scholar 

  25. Tobias-Machado M et al (2017) off-clamp laparoscopic partial nephrectomy for high-complexity tumor: step-by-step of our technique. J Endourol 1:1. https://doi.org/10.1089/vid.2016.0052

    Article  Google Scholar 

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Authors and Affiliations

  1. ABC Medical School, Santo André, SP, Brazil

    Alexandre Stievano Carlos, Igor Nunes-Silva & Marcos Tobias-Machado

  2. Doctor Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, SP, Brazil

    Hamilton de Campos Zampolli

  3. Cajuru Universitary Hospital, Curitiba, PR, Brazil

    Fernando Meyer

  4. Barretos Cancer Hospital, Barretos, SP, Brazil

    Eliney Ferreira Faria

  5. São Paulo, Brazil

    Alexandre Stievano Carlos

Authors
  1. Alexandre Stievano Carlos
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  2. Igor Nunes-Silva
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  3. Hamilton de Campos Zampolli
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  4. Fernando Meyer
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  5. Eliney Ferreira Faria
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  6. Marcos Tobias-Machado
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Correspondence to Alexandre Stievano Carlos.

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Drs. Alexandre Stievano Carlos, Igor Nunes-Silva, Hamilton de Campos Zampolli, Fernando Meyer, Eliney Ferreira Faria and Marcos Tobias-Machado have no conflicts of interest or financial ties to disclose.

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Carlos, A.S., Nunes-Silva, I., Zampolli, H.C. et al. Laparoscopic partial nephrectomy without clamping the renal pedicle. Surg Endosc 34, 3027–3036 (2020). https://doi.org/10.1007/s00464-019-07099-w

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  • DOI: https://doi.org/10.1007/s00464-019-07099-w

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