title: New technique for nephron-sparing surgery in polar tumours. A modification of the Kim technique.
abstract: OBJECTIVE
  Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumours and those larger than 4cm based on the principle of the technique described by Kim in 1964.
  
  
  METHODS
  The technique performs a continuous circular suture on the base of the tumour, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique.
  
  
  RESULTS
  The patients' mean age was 56 years (30-69). The R.E.N.A.L. scores were as follows: 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75-140), and the mean estimated blood loss was 120mL (50-300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2-6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was -0.71mL/min/m2. The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas.
  
  
  CONCLUSIONS
  The proposed technique showed acceptable results, with a low rate of complications in the patient group.
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina. Electronic address: Carlosameri810@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Ameri
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: F M
authors.initials: FM
authors.lastname: Lopez
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: G J
authors.initials: GJ
authors.lastname: Vitagliano
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: H
authors.initials: H
authors.lastname: Rios Pita
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: J M
authors.initials: JM
authors.lastname: Guglielmi
authors.affiliation: Servicio de Urología, Hospital Alemán, Buenos Aires, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Blas
mesh_terms: D018249:Adenoma, Oxyphilic / Q000098:blood supply / Q000601:surgery; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods*; D011446:Prospective Studies; D013536:Suture Techniques; D052096:Warm Ischemia
keywords: Cirugía; Cáncer renal; New technique; Renal cancer; Surgery; Técnica nueva