Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques.
OBJECTIVE
To test the hypothesis that a modified technique for renal parenchymal closure during laparoscopic partial nephrectomy (LPN) enables a significant reduction in warm ischaemia (WIT).


METHODS
Perioperative factors including WIT were prospectively recorded during 40 consecutive LPNs performed by a single experienced laparoscopist. In the first 20 (controls), renal parenchyma was closed by conventional technique (haemostasis and closure of the collecting system with interrupted sutures, then closure of the renal parenchyma over a Surgicel bolster before unclamping the renal artery). In the second consecutive 20 patients (group 1), a modified closure technique was used, which involved earlier arterial unclamping after two (group 1a) or one (group 1b) running suture on the tumour bed. Vascularised renal parenchyma was then closed over a surgical bolster.


RESULTS
All LPNs were performed successfully without conversion. WIT was significantly less in group 1 compared with the control group (27.2+/-5 min vs. 13.7+/-4 min, respectively; p<0.01). WIT was 16.8+/-3.6 vs. 10.3+/-1.2 min in groups 1a and 1b (p<0.01); no other significant differences were observed in perioperative factors. All specimens had negative tumour margins histologically. Major complications and haemoglobin reduction were lower in group 1 compared with the control group.


CONCLUSIONS
The described technique is effective and allows a significant reduction of WIT, even in challenging cases, without increasing perioperative bleeding or morbidity. Its use therefore reduces the need for hypothermic techniques, and allows more time for careful tumour resection and renal reconstruction.
Baumert
Hervé
H
Department of Urology, Paris Saint Joseph Hospital Trust, Paris, France. baumertherve@yahoo.fr
Ballaro
Andrew
A
Shah
Nimish
N
Mansouri
Dhouha
D
Zafar
Nauman
N
Molinié
Vincent
V
Neal
David
D
D000368:Aged; D003404:Creatinine / Q000097:blood; D004322:Drainage; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D007668:Kidney / Q000473:pathology*; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D012079:Renal Circulation
D003404:Creatinine