"Zero ischemia" partial nephrectomy: Novel laparoscopic and robotic technique

Inderbir S. Gill, Manuel S. Eisenberg, Monish Aron, Andre Berger, Osamu Ukimura, Mukul B. Patil, Vito Campese, Duraiyah Thangathurai, Mihir M. Desai

Research output: Contribution to journalArticle

228 Citations (Scopus)

Abstract

Background: Ischemic injury impacts renal function outcomes following partial nephrectomy. Efforts to minimize, better yet, eliminate renal ischemia are imperative. Objective: Describe a novel technique of "zero ischemia" laparoscopic (LPN) and robotic-assisted (RAPN) partial nephrectomy. Design, setting, and participants: Data were prospectively collected into an institutional review board-approved database. Fifteen consecutive patients underwent zero ischemia procedures: LPN (n = 12), RAPN (n = 3). Included were all candidates for LPN or RAPN, irrespective of tumor complexity, including tumors that were central (n = 9; 60%), hilar (n = 1), in solitary kidney (n = 1), in patients with chronic kidney disease grade 3 or greater (n = 3). Anesthesia-related monitoring included pulmonary artery catheter (ie, Swan-Ganz), transesophageal echocardiography, cerebral oximetry, electroencephalographic bispectral index, mixed venous oxygen measurements, and vigorous hydration/diuresis. Pharmacologically induced hypotension was carefully timed to correspond with excision of the deepest aspect of the tumor. Renal parenchymal reconstruction was completed under normotension, ensuring complete hemostasis. Measurements: Intraoperative and early postoperative data were collected prospectively. Results and limitations: All cases were successfully completed without hilar clamping. Ischemia time was zero in all cases. Median tumor size was 2.5 cm (range: 1-4); operative time was 3 h (range: 1.3-6); blood loss was 150 ml (range: 20-400); and hospital stay was 3 d (range: 2-19). Nadir mean arterial pressure ranged from 52-65 mm Hg (median: 60), typically for 1-5 min. No patient had intraoperative transfusion or complication, acute or delayed renal hemorrhage, or hypotension-related sequelae. Postoperative complications (n = 5) included urine retention (n = 1), septicemia from presumed prostatitis (n = 1), atrial fibrillation (n = 1), urine leak (n = 2). Pathology confirmed renal cell carcinoma in 13 patients (87%), all with negative margins. Median pre- and postoperative serum creatinine (0.9 mg/dl and 0.95 mg/dl, respectively) and estimated glomerular filtration rate (eGFR) (75.3 and 72.9, respectively) were comparable. Median absolute and percent change in discharge serum creatinine and eGFR were 0 and 0%, respectively. Conclusions: A novel zero ischemia technique for RAPN and LPN for substantial renal tumors is presented. The initial experience is encouraging.

Original languageEnglish (US)
Pages (from-to)128-134
Number of pages7
JournalEuropean Urology
Volume59
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Robotics
Nephrectomy
Ischemia
Kidney
Neoplasms
Glomerular Filtration Rate
Creatinine
Controlled Hypotension
Urine
Prostatitis
Oximetry
Research Ethics Committees
Diuresis
Transesophageal Echocardiography
Operative Time
Hemostasis
Serum
Chronic Renal Insufficiency
Renal Cell Carcinoma
Constriction

Keywords

  • Ischemia
  • Kidney mass
  • Kidney tumor
  • Laparoscopy
  • Partial nephrectomy
  • Robotic
  • Unclamped

ASJC Scopus subject areas

  • Urology

Cite this

Gill, I. S., Eisenberg, M. S., Aron, M., Berger, A., Ukimura, O., Patil, M. B., ... Desai, M. M. (2011). "Zero ischemia" partial nephrectomy: Novel laparoscopic and robotic technique. European Urology, 59(1), 128-134. https://doi.org/10.1016/j.eururo.2010.10.002

"Zero ischemia" partial nephrectomy : Novel laparoscopic and robotic technique. / Gill, Inderbir S.; Eisenberg, Manuel S.; Aron, Monish; Berger, Andre; Ukimura, Osamu; Patil, Mukul B.; Campese, Vito; Thangathurai, Duraiyah; Desai, Mihir M.

In: European Urology, Vol. 59, No. 1, 01.2011, p. 128-134.

Research output: Contribution to journalArticle

Gill, IS, Eisenberg, MS, Aron, M, Berger, A, Ukimura, O, Patil, MB, Campese, V, Thangathurai, D & Desai, MM 2011, '"Zero ischemia" partial nephrectomy: Novel laparoscopic and robotic technique', European Urology, vol. 59, no. 1, pp. 128-134. https://doi.org/10.1016/j.eururo.2010.10.002
Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Patil MB et al. "Zero ischemia" partial nephrectomy: Novel laparoscopic and robotic technique. European Urology. 2011 Jan;59(1):128-134. https://doi.org/10.1016/j.eururo.2010.10.002
Gill, Inderbir S. ; Eisenberg, Manuel S. ; Aron, Monish ; Berger, Andre ; Ukimura, Osamu ; Patil, Mukul B. ; Campese, Vito ; Thangathurai, Duraiyah ; Desai, Mihir M. / "Zero ischemia" partial nephrectomy : Novel laparoscopic and robotic technique. In: European Urology. 2011 ; Vol. 59, No. 1. pp. 128-134.
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KW - Kidney mass

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