Nephron sparing surgery for renal cell carcinoma using selective renal parenchymal clamping.
OBJECTIVE
We describe a technical artifice facilitating nephron sparing surgery for renal cell carcinoma without clamping the renal pedicle.


METHODS
Selective renal parenchymal clamping was performed using a large curved DeBakey aortic clamp placed around and sufficiently far from the tumor. The lesion was resected with a surrounding margin of normal renal parenchyma. The intrarenal vessels were suture ligated and the collecting system was closed as necessary. Time was not limited since the artery was not clamped.


RESULTS
Ten patients with renal cell carcinoma in whom nephron sparing surgery was indicated underwent selective renal parenchymal clamping. The indication was elective in 8 patients and urgent in 2. The tumor was at the renal pole in 3 cases and peripheral in 7. Mean tumor size was 32 mm. (range 19 to 52). Blood loss was insignificant. Operative time was 81 minutes (range 61 to 125) and there were no perioperative or postoperative complications.


CONCLUSIONS
Selective renal parenchymal clamping is a simple and efficient technical maneuver for facilitating nephron sparing surgery without pedicle dissection and clamping for renal peripheral or pole tumors. Neoplasm location and size are the limiting factors of this technique.
Mejean
Arnaud
A
Department of Urology, Hôpital Necker, Paris, France.
Vogt
Benoit
B
Cazin
Sebastien
S
Balian
Chant
C
Poisson
Jean François
JF
Dufour
Bertrand
B
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009399:Nephrons; D013525:Surgical Instruments; D013520:Urologic Surgical Procedures / Q000379:methods*