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    Korean J Urol. 2009 Dec;50(12):1208-1212. Korean.
    Published online Dec 18, 2009.
    https://doi.org/10.4111/kju.2009.50.12.1208
    Copyright © The Korean Urological Association, 2009
    Original Article

    Laparoscopic Partial Nephrectomy without Renal Arterial Clamping

    Hye Min Hong, Ill Young Seo, and Joung Sik Rim
      • Department of Urology, Wonkwang University School of Medicine, Iksan, Korea.
    • Correspondence to: Ill Young Seo. Department of Urology, Wonkwang University School of Medicine, 344-2, Shinyong-dong, Iksan 570-711, Korea. TEL: 063-859-1333, FAX: 063-842-1455, Email: seraph@wonkwang.ac.kr
    Received May 21, 2009; Accepted November 06, 2009.

    Abstract

    Purpose

    Renal vascular clamping during a laparoscopic partial nephrectomy is a time-consuming procedure with a risk of renal ischemia. To study the feasibility of laparoscopic partial nephrectomy without renal arterial clamping, we compared the procedure with laparoscopic partial nephrectomy with vascular clamping.

    Materials and Methods

    Seventeen patients underwent laparoscopic partial nephrectomy without renal arterial clamping (group 1) from February 2004 to June 2008. The operative results were reviewed retrospectively and compared with those of 16 patients who underwent laparoscopic partial nephrectomy with arterial clamping (group 2). Patient characteristics did not differ significantly between the 2 groups. However, exophytic tumors were detected in 13 patients in group 1 and 3 patients in group 2 (p=0.001). Scores on the preoperative aspects and dimensions used for an anatomical (PADUA) classification were 6.9 in group 1 and 7.7 in group 2 (p=0.037). All surgeries by the transperitoneal approach were performed by a single surgeon.

    Results

    The mean operative times were 103 and 130 minutes in groups 1 and 2, respectively (p=0.312). The mean renal arterial clamping time of group 2 was 27.6 minutes (range, 20-42 minutes). The mean estimated blood loss was 327 ml in group 1 and 315 ml in group 2 (p=0.971). The mean postoperative change in the glomerular filtration rate was 20.11 ml/min/1.73 m2 in group 1 and 18.95 ml/min/1.73 m2 in group 2 (p=0.748). The mean times to postoperative initiation of ambulation and of oral intake were 1.6 and 1.7 days (p=0.486) and 1.3 and 1.6 days (p=0.811) in groups 1 and 2, respectively. The mean length of hospital stay was 7.4 and 7.9 days in groups 1 and 2, respectively (p=0.9). The mean tumor size was 2.1 cm (range, 1-7 cm) in group 1 and 3.3 cm (range, 1.5-9 cm) in group 2.

    Conclusions

    Laparoscopic partial nephrectomy without renal arterial clamping is feasible for a localized renal tumor. However, patients should be selected carefully, such as those with an exophytic tumor.

    Keywords
    Kidney neoplasms; Laparoscopy; Nephrectomy

    Tables

    Table 1
    Patient characteristics

    Table 2
    Operative results

    Table 3
    Pathologic results of renal tumors

    Table 4
    Difference in the glomerular filtration rate in patients who underwent partial nephrectomy

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    MeSH Terms
    Constriction
    Glomerular Filtration Rate
    Humans
    Ischemia
    Kidney Neoplasms
    Laparoscopy
    Length of Stay
    Nephrectomy
    Operative Time
    Retrospective Studies
    Walking
    Metrics
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