title: Nephron sparing surgery for renal cell carcinoma using selective renal parenchymal clamping.
abstract: 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.
authors.affiliation: Department of Urology, Hôpital Necker, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
authors.forename: Benoit
authors.initials: B
authors.lastname: Vogt
authors.forename: Sebastien
authors.initials: S
authors.lastname: Cazin
authors.forename: Chant
authors.initials: C
authors.lastname: Balian
authors.forename: Jean François
authors.initials: JF
authors.lastname: Poisson
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dufour
mesh_terms: 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*