Selective renal parenchymal clamping in retroperitoneal partial nephrectomy.
OBJECTIVE
Herein, we report our experience with retroperitoneoscopic partial nephrectomy (RPN) without hilar occlusion by the use of a laparoscopic clamp to induce selective regional ischemia.


METHODS
A 48-year-old woman was referred for a left upper polar renal mass, which was suspected to be malignant. The contralateral kidney revealed severe atrophy, and she was scheduled to undergo RPN using a laparoscopic clamp to induce selective regional ischemia. At first, the kidney is fully mobilized within the retroperitoneal space. Thereafter, the laparoscopic clamp is applied directly to the kidney, about 1 cm below the resection line. When closed, the renal parenchyma is compressed, so that blood supply to the tumor is interrupted. The preserved portion of the kidney is perfused normally, and it is possible to remove the tumor in a bloodless field without involving warm ischemia.


RESULTS
Renal hilar clamping was avoided, with minimal estimated blood loss. There was no perioperative complication, and the final pathology revealed a hemorrhagic renal cyst. The radioisotope absorption of the enucleated kidney was well maintained, except for the marginal area of the enucleated site. The renogram pattern was found to be equivocal when compared with the preoperative renogram.


CONCLUSIONS
Regional renal parenchymal clamping during RPN can be safely and effectively used to create a bloodless operative field. Moreover, our preliminary experience demonstrates that this technique facilitates maximal nephron-sparing surgery for patients with an anatomically or functionally solitary kidney, without involving warm ischemia.
Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan. nozaki0921@yahoo.co.jp
Tetsuo
T
Nozaki
Hiroaki
H
Iida
Akihiro
A
Morii
Yasuyoshi
Y
Fujiuchi
Hideki
H
Fuse
D003250:Constriction; D005260:Female; D006801:Humans; D007511:Ischemia; D007668:Kidney / Q000098:blood supply / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*