Laparoscopic partial nephrectomy with selective ischemia

Background. Kidney damage caused by long warm ischemic time is one of the most important factors affecting kidney function. Compression of only the segmental artery leading to the tumor is an alternative to total ischemia. Оbjective: to evaluate the effectiveness of laparoscopic partial nephrectomy (LPN) with selective kidney ischemia.

Materials and methods. The results of laparoscopic partial nephrectomy in 68 patients with Т1а (n = 60) and Т1b (n = 8) disease stages and a healthy contralateral kidney were analyzed. Patients with tumors of the solitary kidney weren’t included. The study included 38 (55.9 %) men and 30 (44.1 %) women. Mean age was 58.4 ± 7.8 years. In 36 (52.9 %) patients LPN was performed with compression of the main renal artery (1st group), in 32 (47.1 %) patients the segmental artery was clipped (2^nd group). Mean tumor size in the 1st group was 3.6 ± 1.5 cm (2.5–5.8 cm), in the 2^nd group – 3.2 ± 1.2 cm (2.3–5.2 cm). Surgery duration, warm ischemia time, blood loss volume, and glomerular filtration rate prior to surgical intervention and after it were studies.

Results. All LPNs were concluded with laparoscopic access. There were no conversions to open surgery and nephrectomy. However, in 5  of 32 patients in the 2^nd group, the second branch of the renal artery was compressed due to large blood loss after clipping of one small artery. Surgery duration in the 1^st group was 90.0 ± 18.6 min (65–120 min), in the 2^nd group – 100.0 ± 22.0 min (70–135 min) (р >0.05). Warm ischemia time in the 1st group was significantly lower (16.0 ± 4.2 min versus 22.0 ± 4.6 min). Blood loss volume in the 1st group was 160.0 ± 80.6 ml, in the 2^nd group – 240 ± 160 ml. Glomerular filtration rate before the surgery was 42.4 ± 4.2 ml/min in the 1st group and 42.6 ± 4.2 ml/min in the 2^nd group; 3 months after the surgical intervention, it was 30.6 ± 3.4 and 35.8 ± 3.6 ml/min, respectively (р <0.05).

Conclusion. LPN with compression of the segmental artery directly supplying the tumor prevents ischemia of the whole parenchyma and significant loss of its function in the postoperative period.

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