title: Laparoscopic partial nephrectomy with clamping of the renal parenchyma: initial experience.
abstract: OBJECTIVE
  Partial nephrectomy by laparoscopy offers patients conservative surgery and a mini-invasive approach; however, clamping of the renal pedicle and the induced warm ischaemia can damage the renal parenchyma. We present a technique of laparoscopic partial nephrectomy with haemostasis obtained by clamping of the renal parenchyma.
  
  
  METHODS
  The procedure was performed by an intraperitoneal or a retroperitoneal approach. After a working space is created by pneumodissection, Gerota's fascia is incised and the kidney convexity is dissected. An endoscopic Satinsky clamp is inserted percutaneously through a 1-cm incision. The renal parenchyma is clamped and the tumour is excised in a bloodless field. The cut renal parenchyma is coated with biologic glue.
  
  
  RESULTS
  Five patients with elective indications were operated. Mean age was 67.8 yr and mean tumour diameter 3.06 cm. One lesion was located at the upper pole and four at the lower pole. Mean preoperative serum creatinine level was 10.9 mg/l. Postoperative serum creatinine level was unchanged. Mean operative time was 238 min. There was no conversion. Mean blood loss was 250 ml; no transfusions were necessary. The collecting duct system was repaired in one patient. No complication was noticed. Resection margins were tumour free in all cases. Final pathologic examination revealed clear cell carcinoma in three cases and angiomyolipoma and oncocytoma in one case each.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy with clamping of the renal parenchyma can be performed in selected patients with peripherally placed tumours. The procedure avoids warm ischaemia of the normal parenchyma while allowing the surgeon to operate in an almost bloodless field. This initial experience in five patients should be validated in a larger series.
authors.affiliation: Department of Urology, Rennes University Hospital, Rennes Cedex, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.forename: Andréa
authors.initials: A
authors.lastname: Manunta
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Sébastien
authors.initials: S
authors.lastname: Vincendeau
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: François
authors.initials: F
authors.lastname: Guillé
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011859:Radiography; D015427:Reperfusion Injury / Q000517:prevention & control*; D016896:Treatment Outcome