title: ZIRK-Technique: Zero Ischemia Resection in the Kidney for High-Risk Renal Masses: Perioperative Outcome.
abstract: OBJECTIVE
  This study evaluates the feasibility and safety of open-partial nephrectomies in the ZIRK-technique (Zero Ischemia Resection in the Kidney) for renal masses with high-risk anatomical features--objectified by the PADUA score.
  
  
  METHODS
  We identified 40 consecutive cases of partial nephrectomies performed without clamping of the renal artery in our department of urology. Retrospective analysis of the preoperative CT or MRI scans showed 27 cases with a PADUA score ≥8, of which 15 cases had a score ≥10. Cases were in particular assessed regarding operation time (ORT), estimated blood loss (EBL), surgical margins and postoperative complications using the Clavien classification.
  
  
  RESULTS
  The mean age of the study population was 67.6 years with an average BMI of 26.8 kg/m2. The mean ORT was 1:46 with an average EBL of 521 ml. Clavien grade II complications were observed seven times, while 3 patients had a grade IIIa complication. Despite complex and adverse location of the tumors, nephron-sparing surgery without ischemia could be performed with negative surgical margins for all cases. EBL, transfusion rate and complication were considerably more frequent in high-risk tumors.
  
  
  CONCLUSIONS
  Highly complex renal tumors, PADUA ≥10, can be resected in ZIRK-technique with good operative outcome and a low complication rate.
authors.affiliation: Department of Urology, University Medical Centre Mannheim, Mannheim, Germany.
authors.forename: Maximilian C
authors.initials: MC
authors.lastname: Kriegmair
authors.forename: Daniel
authors.initials: D
authors.lastname: Pfalzgraf
authors.forename: Axel
authors.initials: A
authors.lastname: Häcker
authors.forename: Maurice Stephan
authors.initials: MS
authors.lastname: Michel
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009399:Nephrons / Q000601:surgery; D061646:Operative Time; D059035:Perioperative Period; D012077:Renal Artery / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome