ZERO ISCHEMIA LAPAROSCOPIC PARTIAL NEPHRECTOMY: PRELIMINARY EXPERIENCE
LPN is now reference standard for T1 renal tumors. Hilar clamping necessarily imposes kidney ischemic injury. ”Zero ischemia” partial nephrectomy allows to eliminate ischemia during nephron sparing surgery. We report our preliminary experience of “zero ischemia” LPN (ZILPN).
Materials and methods
Patients with a single T1 tumor were candidates for ZILPN. The preoperative work-up comprised medical history, physical examination, routine laboratory tests and CT scan or MRI. A transperitoneal approach was performed in all patients. Intraoperative monitoring includes electrocardiogram, central venous pressure, electroencephalographic bispectral index, NICOM (non invasive cardiac output monitoring), urinary catheter. A controlled hypotension is maintened at approximately 60 mmHg. To induce hypotension, the doses of inhalational isoflurane is increased. The renal lesion is excised using cold endoshears Upon completion of tumor excision, blood pressure is restored to preoperative levels. Parenchyma is repaired with Vicryl™ sutures arrested with absorbable clips and Hem-O-lok™.
27 patients affected by renal tumor (8 right, 19 left) underwent zero ischemia LPN. Mean age and mean BMI were 57.6 (±9.8) years and 27.7 (±7.2). ASA score was 1, 2 and 3 in 1, 13 and 13 patients, respectively. Renal score was 6 (4 pts), 7 (4 pts), 8 (3 pts), 9 (12 pts), 10 (2pts), 11 (2 pts)
Mean tumor size was 41.6 mm (±18.6). Operative time, blood loss, ∆Hb were 117 min (±45.9), 217 ml (±254.6), 2.0 gr/dl (±0.9), respectively. Blood transfusion was necessary in 2 patients. In all cases the procedure was performed without clamping. Hospital stay was 6.8 (±2.8) days. Three patients (11%) developed postoperative complications: 2 fever and 1 urine leakage managed conservatively (Clavien grade 1). Histological evaluation revealed 4 Oncocytoma, 1 AML, 22 RCC (15 pT1a, 7 pT1b).
Zero ischemia LPN represents a safe and reproducible technique that allow to sparing renal parenchyma and preserve renal function.