Laparoscopic partial nephrectomy with superselective balloon embolization of renal artery

Abstract

To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.