title: Laparoscopic partial nephrectomy with "on-demand" clamping reduces warm ischemia time.
abstract: OBJECTIVE
  To investigate the impact of "on-demand" clamping during laparoscopic partial nephrectomy on warm ischemia time.
  
  
  METHODS
  We retrospectively reviewed 39 consecutive patients with renal tumors who had undergone transperitoneal laparoscopic partial nephrectomy from April 2002 to May 2006. Median tumor size was 2.3 cm. In all cases, the hilum was dissected early and extracorporeal clamping performed. The pedicle was clamped only in case of excessive bleeding, and it was released immediately after the closure of the renal defect with knot-tying sutures over Surgicel bolsters.
  
  
  RESULTS
  Median operative time was 120 min. Renal clamping was required in 31 of 39 patients and in this subgroup the median warm ischemia time was 9 min. Median operative blood loss was 150 ml. Eight patients required blood transfusion and among these two were converted to open surgery. Positive surgical margin was observed in one case. Renal cell carcinoma was present in 22 (54.4%) specimens. No recurrence was observed after a median follow-up of 15 mo.
  
  
  CONCLUSIONS
  This novel technique using extracorporeal clamping significantly decreases warm ischemia time, avoiding clamping of the pedicle in selected cases. Our study underlines the feasibility of performing laparoscopic partial nephrectomy with extracorporeal hilar clamping, allowing the shortest ischemia time ever published.
authors.affiliation: Department of Urology, Erasme Hospital, University Clinics, Brussels, Belgium. renaud.bollens@ulb.ac.be
authors.forename: Renaud
authors.initials: R
authors.lastname: Bollens
authors.forename: Alberto
authors.initials: A
authors.lastname: Rosenblatt
authors.forename: Baldo P
authors.initials: BP
authors.lastname: Espinoza
authors.forename: Alexandre
authors.initials: A
authors.lastname: De Groote
authors.forename: Thierry
authors.initials: T
authors.lastname: Quackels
authors.forename: Thierry
authors.initials: T
authors.lastname: Roumeguere
authors.forename: Marc
authors.initials: M
authors.lastname: Vanden Bossche
authors.forename: Eric
authors.initials: E
authors.lastname: Wespes
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Zlotta
authors.forename: Claude C
authors.initials: CC
authors.lastname: Schulman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D015427:Reperfusion Injury / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome