title: Evaluation of functional outcomes after laparoscopic partial nephrectomy using renal scintigraphy: clamped vs clampless technique.
abstract: OBJECTIVE
  To examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy (LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN.
  
  
  METHODS
  Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time (WIT): group A, conventional LPN and group B, clampless-LPN (WIT = 0 min). Demographic and peri-operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi-squared and Student's t-tests were carried out and regression analysis was performed.
  
  
  RESULTS
  Group A was found to be similar to group B in all variables measured except for WIT and blood loss (P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney.
  
  
  CONCLUSIONS
  In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function.
authors.affiliation: Division of Urology, University of Turin, 'San Luigi Gonzaga' Hospital, Orbassano, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.forename: Daniele
authors.initials: D
authors.lastname: Amparore
authors.forename: Valerio
authors.initials: V
authors.lastname: Podio
authors.forename: Tiziana
authors.initials: T
authors.lastname: Angusti
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017595:Renal Plasma Flow / Q000502:physiology; D016896:Treatment Outcome
keywords: clampless; laparoscopy; partial nephrectomy; renal ischaemia; renal scintigraphy; zero ischaemia