Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine.
OBJECTIVE
Laparoscopic partial nephrectomy (LPN) has been shown to be a safe and effective option for small renal tumors. However, limited data are available regarding the effect of warm ischemic time on postoperative renal function. We assessed the effect of variable durations of warm ischemia on long-term renal function in patients undergoing LPN.


METHODS
A total of 118 patients with a single, unilateral, sporadic renal tumor and normal contralateral kidney underwent LPN from August 1998 to November 2002. Patients were divided into 3 groups based on warm ischemic time, namely group 1-no renal occlusion in 42, group 2-warm ischemia less than 30 minutes in 48 and group 3-warm ischemia greater than 30 minutes in 28. All 3 groups were assessed for changes in serum creatinine 6 months after LPN. Additionally, renal remnants were examined with cross-sectional imaging.


RESULTS
At a median followup of 28 months (range 6 to 56) median creatinine had not statistically increased postoperatively. None of the 118 patients progressed to renal insufficiency or required dialysis after LPN.


CONCLUSIONS
Based on postoperative serum creatinine warm ischemia time up to 55 minutes does not significantly influence long-term renal function after LPN. Thus, during LPN efforts to minimize warm ischemia are important but they should not jeopardize cancer control, hemostasis or collecting system closure.
Bhayani
Sam B
SB
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
Rha
Koon H
KH
Pinto
Peter A
PA
Ong
Albert M
AM
Allaf
Mohamad E
ME
Trock
Bruce J
BJ
Jarrett
Thomas W
TW
Kavoussi
Louis R
LR
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000097:blood / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009926:Organ Preservation; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis*; D013696:Temperature; D013997:Time Factors
D003404:Creatinine