title: Modified anatrophic partial nephrectomy with selective renal segmental artery clamping to preserve renal function: a preliminary report.
abstract: OBJECTIVE
  Partial nephrectomy is effective for preserving renal function, but temporary clamping of the renal artery for hemorrhagic control may impair renal function due to ischemia/reperfusion injury. Anatrophic partial nephrectomy (APNx) has been proposed to minimize renal ischemia/reperfusion injury by clamping only the feeding artery. We aimed to evaluate whether anatrophic partial nephrectomy (APNx) is useful in preserving renal function and to assess variations in renal artery anatomy to determine the feasibility of selective segmental artery clamping.
  
  
  METHODS
  We performed preoperative renal angiography to evaluate the utility of APNx. Perioperative changes in renal function were compared between the APNx group and a standard partial nephrectomy group.
  
  
  RESULTS
  APNx was successful in 18 patients. The mean lengths of the feeding artery on preoperative angiography were 20.5 and 6 mm for successful and unsuccessful cases, respectively. It was not difficult to clamp the feeding artery in 16 patients with lengths >10 mm or with multiple renal arteries. Evaluation of renovascular variations on 116 renal angiograms indicated that APNx was feasible for 60% and 40% on the right and left sides, respectively. The short-term increase in the serum creatinine level was significantly smaller after APNx than it was after standard partial nephrectomy.
  
  
  CONCLUSIONS
  APNx minimizes ischemic/reperfusion injury and preserves renal function while achieving hemorrhage control. As it can be performed safely in about 50% of cases, it may be the option for patients with renal impairment or a solitary kidney.
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan. nohara704@yahoo.co.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nohara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.forename: Kenrou
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Gabata
authors.forename: Mikio
authors.initials: M
authors.lastname: Namiki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D003250:Constriction; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery