title: Retrospective Analysis of Laparoscopic Partial Nephrectomies Using the Zero Ischemia Technique.
abstract: OBJECTIVE
  To report a series of 89 off-clamp laparoscopic partial nephrectomies (LPN) performed without using any additional "nephron sparing" manipulations.
  
  
  METHODS
  Retrospective analysis of surgical characteristics, complications, postoperative results, and renal function changes.
  
  
  RESULTS
  Between March 2008 and May 2014, 89 LPN using zero ischemia technique were performed. Most of the patients (61.8%) were male. The median age was 62 years (23-88). The mean BMI was 27.5 kg/m2 (20.8-54.2). The median tumor size was 3.0 cm (1.0-8.0). Tumor location was upper, middle, and lower part of the kidney in 33 (37.0%), 42 (47.2%), and 14 (15.7%) of patients, respectively. The median operative time was 154 min (58-289). The median hemoglobin change was -1.6 g/dL (0.5-5.5). The transfusion rate was 7.9%. The mean preoperative glomerular filtration rate was 96.6 mL/min (21.5-180.0) with a mean postoperative decline of 6.52 mL/min. The mean creatinine elevation after LPN was 0.09 mg/dL. The median hospital stay was 6 days (2-24). The intraoperative complications rate was 2.3%. Early postoperative complication rate was 33.7%. Late complications occurred in 6.7%. In 7 cases (7.9%), the surgical margins were microscopically involved by tumor cells. Conversion rate was 3.4%.
  
  
  CONCLUSIONS
  Data obtained in the current series show that laparoscopic partial nephrectomy can be successfully performed without hilar clamping. Our results are comparable with contemporary data. Larger prospective studies would be helpful in assessing the evidence-based advantages of the "zero ischemia" technique.
authors.affiliation: Department of Urology, Carmel Medical Center, Haifa, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Boyarsky
authors.forename: Avi
authors.initials: A
authors.lastname: Stein
authors.forename: Alex
authors.initials: A
authors.lastname: Konstantinovsky
authors.forename: Dmitry
authors.initials: D
authors.lastname: Goldin
authors.forename: Ilan
authors.initials: I
authors.lastname: Klein
authors.forename: Tal
authors.initials: T
authors.lastname: May
authors.forename: Yuval
authors.initials: Y
authors.lastname: Freifeld
authors.forename: Yahya
authors.initials: Y
authors.lastname: Moaad
authors.forename: Yoram
authors.initials: Y
authors.lastname: Dekel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects; D055815:Young Adult
keywords: Laparoscopic partial nephrectomy; No clamp; Zero ischemia