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V34 Robotic partial nephrectomy for hilar tumours: Zero ischemia or early unclamping?
V34
Robotic partial nephrectomy for hilar tumours: Zero ischemia or early unclamping? Eur Urol Suppl 2016;15(3);eV34
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Peyronnet B., Pradère B., Alimi Q., Khene Z., Fardoun T., Mathieu R., Verhoest G., Bensalah K. CHU Rennes, Dept. of Urology, Rennes, France INTRODUCTION & OBJECTIVES: An arterial clamping is usually performed during partial nephrectomy in order to decrease blood loss and improve vision during tumorectomy. However, it causes warm ischemia which is potentially harmful for the kidney. The concept of “zero ischemia” robotic partially nephrectomy appeared in the early 2010’s. Its aim is to avoid warm ischemia time by omitting to clamp the main renal artery. The aim of this video was to compare two managements of the renal pedicle during robotic partial nephrectomy for hilar tumours: early unclamping vs. zero ischemia. MATERIAL & METHODS: We present 2 cases of robotic partial nephrectomy for complex (RENAL NEPHROMETRY score ≥ 7) and hilar tumours. In the first case, a 6 cm tumour of the left kidney has been diagnosed in a 57 year-old male. RENAL NEPHROMETRY score was 10-ph. The main renal artery was clamped with an early unclamping (unclamping after one or two running suture in the tumour bed but before parenchymal repair). In the second case, a 4 cm totally endophytic tumour of the left kidney arised in a 66 year-old male. RENAL NEPHROMETRY score was 9-h. An off-clamp technique was chosen. RESULTS: In the first case, warm ischemia time was 24 minutes and estimated blood loss was 500 ml. There were no transfusions or postoperative complications. The patient was discharged on postoperative day 5. Surgical margins were negative. At 1 month postoperatively, 88% of renal function was preserved. In the second case, an important bleeding occurred during tumorectomy. First, the surgeon switched to a selective arterial clamping. The bleeding continued and the surgeon had to clamp the main renal artery. Warm ischemia time was 8 minutes and estimated blood loss was 1200 ml. There were no transfusions or postoperative complications. The patient was discharged on postoperative day 4. Surgical margins were negative. At 1 month postoperatively, 86% of renal function was preserved. CONCLUSIONS: Hilar tumours are good candidates for the “zero ischemia” techniques during robotic partial nephrectomy. However, they could lead to important bleeding that could increase the surgical morbidity and the risk of positive margins. As recent data suggest that a limited warm ischemia time (< 30 minutes) could have no impact on renal function, the early unclamping technique, which appear safer, could be the preferred option in these patients.
Robotic partial nephrectomy for hilar tumours: Zero ischemia or early unclamping? Eur Urol Suppl 2016;15(3);eV34
Print! Print!
Peyronnet B., Pradère B., Alimi Q., Khene Z., Fardoun T., Mathieu R., Verhoest G., Bensalah K. CHU Rennes, Dept. of Urology, Rennes, France INTRODUCTION & OBJECTIVES: An arterial clamping is usually performed during partial nephrectomy in order to decrease blood loss and improve vision during tumorectomy. However, it causes warm ischemia which is potentially harmful for the kidney. The concept of “zero ischemia” robotic partially nephrectomy appeared in the early 2010’s. Its aim is to avoid warm ischemia time by omitting to clamp the main renal artery. The aim of this video was to compare two managements of the renal pedicle during robotic partial nephrectomy for hilar tumours: early unclamping vs. zero ischemia. MATERIAL & METHODS: We present 2 cases of robotic partial nephrectomy for complex (RENAL NEPHROMETRY score ≥ 7) and hilar tumours. In the first case, a 6 cm tumour of the left kidney has been diagnosed in a 57 year-old male. RENAL NEPHROMETRY score was 10-ph. The main renal artery was clamped with an early unclamping (unclamping after one or two running suture in the tumour bed but before parenchymal repair). In the second case, a 4 cm totally endophytic tumour of the left kidney arised in a 66 year-old male. RENAL NEPHROMETRY score was 9-h. An off-clamp technique was chosen. RESULTS: In the first case, warm ischemia time was 24 minutes and estimated blood loss was 500 ml. There were no transfusions or postoperative complications. The patient was discharged on postoperative day 5. Surgical margins were negative. At 1 month postoperatively, 88% of renal function was preserved. In the second case, an important bleeding occurred during tumorectomy. First, the surgeon switched to a selective arterial clamping. The bleeding continued and the surgeon had to clamp the main renal artery. Warm ischemia time was 8 minutes and estimated blood loss was 1200 ml. There were no transfusions or postoperative complications. The patient was discharged on postoperative day 4. Surgical margins were negative. At 1 month postoperatively, 86% of renal function was preserved. CONCLUSIONS: Hilar tumours are good candidates for the “zero ischemia” techniques during robotic partial nephrectomy. However, they could lead to important bleeding that could increase the surgical morbidity and the risk of positive margins. As recent data suggest that a limited warm ischemia time (< 30 minutes) could have no impact on renal function, the early unclamping technique, which appear safer, could be the preferred option in these patients.