The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping. MATERIALS AND METHODS: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning. RESULTS: Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). CONCLUSIONS: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.