Zero ischemia anatomical partial nephrectomy

A novel approach

Inderbir S. Gill, Mukul B. Patil, Andre Luis De Castro Abreu, Casey Ng, Jie Cai, Andre Berger, Manuel S. Eisenberg, Masahiko Nakamoto, Osamu Ukimura, Alvin C. Goh, Duraiyah Thangathurai, Monish Aron, Mihir M. Desai

Research output: Contribution to journalArticle

163 Citations (Scopus)

Abstract

Purpose: We present a novel concept of zero ischemia anatomical robotic and laparoscopic partial nephrectomy. Materials and Methods: Our technique primarily involves anatomical vascular microdissection and preemptive control of tumor specific, tertiary or higher order renal arterial branch(es) using neurosurgical aneurysm micro-bulldog clamps. In 58 consecutive patients the majority (70%) had anatomically complex tumors including central (67%), hilar (26%), completely intrarenal (23%), pT1b (18%) and solitary kidney (7%). Data were prospectively collected and analyzed from an institutional review board approved database. Results: Of 58 cases undergoing zero ischemia robotic (15) or laparoscopic (43) partial nephrectomy, 57 (98%) were completed without hilar clamping. Mean tumor size was 3.2 cm, mean ± SD R.E.N.A.L. score 7.0 ± 1.9, C-index 2.9 ± 2.4, operative time 4.4 hours, blood loss 206 cc and hospital stay 3.9 days. There were no intraoperative complications. Postoperative complications (22.8%) were low grade (Clavien grade 1 to 2) in 19.3% and high grade (Clavien grade 3 to 5) in 3.5%. All patients had negative cancer surgical margins (100%). Mean absolute and percent change in preoperative vs 4-month postoperative serum creatinine (0.2 mg/dl, 18%), estimated glomerular filtration rate (-11.4 ml/minute/1.73 m 2, 13%), and ipsilateral kidney function on radionuclide scanning at 6 months (-10%) correlated with mean percent kidney excised intraoperatively (18%). Although 21% of patients received a perioperative blood transfusion, no patient had acute or delayed renal hemorrhage, or lost a kidney. Conclusions: The concept of zero ischemia robotic and laparoscopic partial nephrectomy is presented. This anatomical vascular microdissection of the artery first and then tumor allows even complex tumors to be excised without hilar clamping. Global surgical renal ischemia is unnecessary for the majority of patients undergoing robotic and laparoscopic partial nephrectomy at our institution.

Original languageEnglish (US)
Pages (from-to)807-815
Number of pages9
JournalJournal of Urology
Volume187
Issue number3
DOIs
StatePublished - Mar 2012
Externally publishedYes

Fingerprint

Nephrectomy
Ischemia
Kidney
Robotics
Neoplasms
Microdissection
Constriction
Blood Vessels
Research Ethics Committees
Intraoperative Complications
Operative Time
Glomerular Filtration Rate
Radioisotopes
Blood Transfusion
Aneurysm
Length of Stay
Creatinine
Arteries
Databases
Hemorrhage

Keywords

  • ischemia
  • laparoscopy
  • nephrectomy
  • robotics

ASJC Scopus subject areas

  • Urology

Cite this

Gill, I. S., Patil, M. B., De Castro Abreu, A. L., Ng, C., Cai, J., Berger, A., ... Desai, M. M. (2012). Zero ischemia anatomical partial nephrectomy: A novel approach. Journal of Urology, 187(3), 807-815. https://doi.org/10.1016/j.juro.2011.10.146

Zero ischemia anatomical partial nephrectomy : A novel approach. / Gill, Inderbir S.; Patil, Mukul B.; De Castro Abreu, Andre Luis; Ng, Casey; Cai, Jie; Berger, Andre; Eisenberg, Manuel S.; Nakamoto, Masahiko; Ukimura, Osamu; Goh, Alvin C.; Thangathurai, Duraiyah; Aron, Monish; Desai, Mihir M.

In: Journal of Urology, Vol. 187, No. 3, 03.2012, p. 807-815.

Research output: Contribution to journalArticle

Gill, IS, Patil, MB, De Castro Abreu, AL, Ng, C, Cai, J, Berger, A, Eisenberg, MS, Nakamoto, M, Ukimura, O, Goh, AC, Thangathurai, D, Aron, M & Desai, MM 2012, 'Zero ischemia anatomical partial nephrectomy: A novel approach', Journal of Urology, vol. 187, no. 3, pp. 807-815. https://doi.org/10.1016/j.juro.2011.10.146
Gill IS, Patil MB, De Castro Abreu AL, Ng C, Cai J, Berger A et al. Zero ischemia anatomical partial nephrectomy: A novel approach. Journal of Urology. 2012 Mar;187(3):807-815. https://doi.org/10.1016/j.juro.2011.10.146
Gill, Inderbir S. ; Patil, Mukul B. ; De Castro Abreu, Andre Luis ; Ng, Casey ; Cai, Jie ; Berger, Andre ; Eisenberg, Manuel S. ; Nakamoto, Masahiko ; Ukimura, Osamu ; Goh, Alvin C. ; Thangathurai, Duraiyah ; Aron, Monish ; Desai, Mihir M. / Zero ischemia anatomical partial nephrectomy : A novel approach. In: Journal of Urology. 2012 ; Vol. 187, No. 3. pp. 807-815.
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