title: Clampless laparoscopic partial nephrectomy: a step towards a harmless nephron-sparing surgery?
abstract: OBJECTIVE
  To evaluate the results of our technique of clampless laparoscopic partial nephrectomy (LPN) and its impact as an emerging treatment for small renal masses (SMRs).
  
  
  METHODS
  We reviewed our prospectively maintained database: data of 117 patients who consecutively underwent LPN at our Institution from January 2009 to December 2011 were studied. Patients were divided into 2 Groups based on operative technique: Group A: clampless-LPN (cl-LPN); Group B: conventional LPN (clamping of renal artery). Demographic and peri-operative data, complications, pre- and post-operative serum creatinine and estimated glomerular filtration rate (eGFR) were registered and compared by Student's t- and Chi-square-tests (p-values < 0.05 considered statistically significant).
  
  
  RESULTS
  41 patients were in Group A and 76 in Group B. Groups were comparable in terms of preoperative data except for tumour's size (2.35 ± 1.10 vs. 3.19 ± 1.57, Group A vs. B, respectively, p = 0.0029). Concerning perioperative data, warm ischemia time (WIT) was 0 min. in all Group A cases; mean WIT in Group B was 20.90 ± 9.27 min. One case (2.4%) in Group A (central tumour) was converted to conventional LPN. Mean eGFR postoperative decrease was higher in Group B (0.17 ± 9.30 vs. 4.38 ± 11.37 mL/min., A vs B, respectively, p = 0.0445).
  
  
  CONCLUSIONS
  Notwithstanding the limits of the study, our results suggest that cl-LPN is a safe and effective technique, which allows surgeon to surgically treat SRMs even in case of complex location, without injuring kidney by ischemia.
authors.affiliation: Division of Urology - San Luigi Gonzaga Hospital - Orbassano (Turin), Italy. porpiglia@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.forename: Ivano
authors.initials: I
authors.lastname: Morra
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D009399:Nephrons / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome