Clampless Laparoscopic Partial Nephrectomy Research Articles

Radiofrequency-assisted, laparoscopic, clampless partial nephrectomy in patients with low-complexity small renal tumors: A retrospective cohort study.

This single-center, retrospective study was performed to investigate the safety and efficacy of radiofrequency-assisted (RF), laparoscopic partial nephrectomy (PN) with zero ischemia in patients with low-complexity small renal tumors. Patients with small renal masses (SRMs) who underwent laparoscopic, clampless laparoscopic partial nephrectomy - radiofrequency assisted (LPN-RFA) between January 2016 and June 2020 were studied. Demographics, clinical and pathological characteristics, recurrence-free survival, and overall survival were recorded. Fifty-two SRMs were excised from corresponding patients using RFA-LPN. The median tumor size was 2.5 cm and all specimens involved low-complexity masses according to the renal nephrometry score. No conversions to radical nephrectomy were recorded. Postoperatively, there were one patient with fever, one with hematuria, and two with urinary leakage treated endoscopically. The majority of tumors (48/52, 86.2%) were clear-cell carcinomas. According to the glomerular filtration rate postoperatively and 12 months' posttreatment, adequate renal function was preserved in all patients. There were no positive surgical margins identified postoperatively and no recurrences during a median follow-up 24 months. All patients were alive at the last follow-up. This study suggests that RFA laparoscopic clampless PN represents an effective method for managing patients with low-complexity SRMs. It offers adequate intraoperative safety and excellent mid-term oncological control and functional preservation.

V3-09 NEPHRON-SPARING LAPAROSCOPIC PARTIAL NEPHRECTOMY AFTER SUPERSELECTIVE EMBOLIZATION OF A RENAL TUMOR IN A HYBRID OPERATING ROOM: A NEW APPROACH OF ZERO ISCHAEMIA

You have accessJournal of UrologyRenal Oncology1 Apr 2017V3-09 NEPHRON-SPARING LAPAROSCOPIC PARTIAL NEPHRECTOMY AFTER SUPERSELECTIVE EMBOLIZATION OF A RENAL TUMOR IN A HYBRID OPERATING ROOM: A NEW APPROACH OF ZERO ISCHAEMIA Paul Panayotopoulos, Antoine Bouvier, and Pierre Bigot Paul PanayotopoulosPaul Panayotopoulos More articles by this author , Antoine BouvierAntoine Bouvier More articles by this author , and Pierre BigotPierre Bigot More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.724AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To perform nephron-sparing surgery, arterial clamping is often required. Operative bleeding control is difficult in laparoscopic techniques. We imagined a novel technique for “zero ischemia” nephron-sparing surgery using a hybrid opearating room: clampless laparoscopic partial nephrectomy was performed after superselective tumoral embolization. Our objective is to describe this new technique. METHODS The patient is a 46 year old patient with no prior medical history, who had a 3 cm large localized renal tumor on the convexity of the left kidney. The lesion was heterogeneous, medial, partially endophytic and of moderate complexity (RENAL 8p). The procedure was realized in a hybrid operating room by a double team: interventional radiologist and urologist. RESULTS A first renal arteriography was made to visualize the arterial vascularization of the left kidney. With a guidance software, the tumoral artery was catheterized superselectively. The tumor and its arteries were embolized by microspheres and coils. A 3D arteriography showed the exclusion of the tumor from the renal vascularization. Then, the patient was positionned for laparoscopic partial nephrectomy, thas was performed without dissecting the renal pedicule, nor clamping of the renal artery. Operative bleeding was insignificant. No suture was necessary. A final control 3D arteriography showed no arterial bleeding and preservation of healthy renal parenchyma. Follow-up was uneventful. Preoperative renal function was maintained. The tumor was a clear cell renal carcinoma. Surgical margins were negative. CONCLUSIONS This is the first experience of superselective tumoral embolization followed immediately by laparoscopic partial nephrectomy in a hybrid operating room. Resection of a localized renal cancer of moderate complexity was performed clampless, sutureless and without intraoperative bleeding. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e291 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul Panayotopoulos More articles by this author Antoine Bouvier More articles by this author Pierre Bigot More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

983 Intraoperative, postoperative and functional outcomes of clampless laparoscopic partial nephrectomy (LPN) for renal tumours with high surgical complexity

983 Intraoperative, postoperative and functional outcomes of clampless laparoscopic partial nephrectomy (LPN) for renal tumours with high surgical complexity

Evaluation of functional outcomes after laparoscopic partial nephrectomy using renal scintigraphy: clamped vs clampless technique.

To examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy (LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN. Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time (WIT): group A, conventional LPN and group B, clampless-LPN (WIT = 0 min). Demographic and peri-operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi-squared and Student's t-tests were carried out and regression analysis was performed. Group A was found to be similar to group B in all variables measured except for WIT and blood loss (P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney. In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function.

204 Kidney injury following clampless laparoscopic partial nephrectomy: Is an early detection of acute postoperative damage possible? A preliminary experience

204 Kidney injury following clampless laparoscopic partial nephrectomy: Is an early detection of acute postoperative damage possible? A preliminary experience

Radiofrequency Coagulation-Assisted Laparoscopic Partial Nephrectomy Without Hilar Clamping: A Feasible Technique With Excellent Outcomes in Highly Selected Patients

The Habib radiofrequency coagulation (RFC) device coagulates bleeding surfaces and may eliminate the need for hilar clamping, thus eliminating warm ischemia time and decreasing the technical complexity of laparoscopic partial nephrectomy (LPN). We retrospectively review a series of patients who underwent clampless LPN with RFC to study the safety and feasibility of this approach. The Institutional Review Board-approved, Johns Hopkins Minimally Invasive Urologic Surgery Database (1994-2011) was queried for patients undergoing clampless LPN with RFC between September 2008 and January 2010 by a single surgeon (MEA). Respecting a 0.5-cm surgical margin, the lesion was circumscribed with the RFC device to create an avascular plane, and standard laparoscopic shears were used to excise the tumor in a bloodless field without hilar clamping. Patient outcomes were analyzed for safety and feasibility of this approach. Fifteen patients underwent RFC LPN. Median tumor diameter in our patients was 1.6 cm (range 1-7.3 cm). Seven (46.7%) tumors were exophytic in nature, and the remainder were mesophytic. Median nephrometry score was 5 (range 4 to 7). Median operative time was 155 minutes (range 100-210 min), and median estimated blood loss was 100 mL (50-500 mL). There were no positive margins, and two postoperative complications (urine leak and clot retention) were encountered. No recurrences were noted with short-term follow-up. Clampless RFC LPN can be performed safely in carefully selected patients with favorably positioned tumors. In this initial experience, we observed excellent perioperative and short-term oncologic outcomes. Future comparative studies will dictate the role of RFC-assisted LPN in the armamentarium of kidney surgeons.