Fighting warm ischemia: Selective arterial clamping using ICG-fluorescent guidance during 3D laparoscopic nephron sparing surgery

Aim: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Materials and methods: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. Results: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4–6), five patients medium complexity score (i.e. 7–9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. Conclusion: Large AML’s are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.

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Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique

Journal of International Medical Research ◽

10.1177/0300060518760737 ◽

2018 ◽

Vol 46 (4) ◽

pp. 1649-1656 ◽

Cited By ~ 1

Author(s):

Jianfei Ye ◽

Shudong Zhang ◽

Xiaojun Tian ◽

Guoliang Wang ◽

Lei Zhao ◽

...

Keyword(s):

Operative Time ◽

Suture Technique ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Nephron Sparing Surgery ◽

Barbed Suture ◽

Ischemia Time ◽

Sutureless Technique ◽

Nephron Sparing ◽

The Mean

Objective Laparoscopic knot-tying and suturing are the most difficult steps in shortening the warm ischemia time and learning curve of laparoscopic nephron-sparing surgery. This study was performed to demonstrate the safety, oncological efficacy, and technical tips of sutureless retroperitoneal laparoscopic nephron-sparing surgery (RPNSS). Methods This retrospective study included 78 cases of RPNSS using a sutureless technique and 126 cases of RPNSS using a single-layer barbed self-retaining suture technique performed from December 2012 to December 2016. Results The mean warm ischemia time was significantly shorter in the sutureless technique group than in the barbed self-retaining suture technique group (6.8 vs. 21.1 minutes, respectively). There was no significant difference in the mean age, body mass index, R.E.N.A.L. Nephrometry score, operative time, maximal tumor diameter, intraparenchymal depth, blood loss, operative time, transfusion rate, complication rate, or postoperative hospital stay between the two groups. No open conversion was needed. No positive margins or local recurrence were observed during follow-up. Conclusions The sutureless technique was proven to be safe and oncologically effective and may allow novice laparoscopic surgeons to easily and quickly master RPNSS, a technically difficult procedure.

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MP-04.04: Techniques for Reducing Renal Warm Ischemia Time for Laparoscopic Nephron-Sparing Surgery

Urology ◽

10.1016/j.urology.2009.07.1026 ◽

2009 ◽

Vol 74 (4) ◽

pp. S58

Author(s):

B. Fu ◽

G. Wang ◽

T. Sun ◽

S. Cui ◽

R. Cao ◽

...

Keyword(s):

Warm Ischemia ◽

Warm Ischemia Time ◽

Nephron Sparing Surgery ◽

Ischemia Time ◽

Nephron Sparing

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A prospective, multi-institutional study of perioperative morbidities in the patients of renal cell carcinoma undergoing either open nephron sparing surgery or robotic nephron sparing surgery in fifty cases

International Surgery Journal ◽

10.18203/2349-2902.isj20193155 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2785

Author(s):

Mahesh Chandra ◽

Seema Wasnik ◽

Shailesh Karan

Keyword(s):

Renal Cell Carcinoma ◽

Blood Transfusion ◽

Blood Loss ◽

Hospital Stay ◽

Renal Cell ◽

Warm Ischemia ◽

Nephron Sparing Surgery ◽

Perioperative Morbidity ◽

Renal Pedicle ◽

Nephron Sparing

Background: Over the time, the nephron sparing surgery (NSS) has become ‘gold standard’ for treatment of T1a stage renal cell carcinoma (RCC) which saves precious renal tissue. We assessed and compared perioperative morbidities associated with open (ONSS) and robotic nephron sparing surgery (RNSS) in patients of T1a and T1b staged renal cell carcinoma.Methods: This prospective study was carried out from April 2016 to March 2018. A total of fifty (n=50) RCC patients underwent open or robotic nephron sparing surgery. The demographic data and perioperative morbidities associated with both methods of NSS were recorded and comparison of parameters including warm-ischemia time (WIT), hospital stay, perioperative bleeding, impact of renal-pedicle clamping was made in T1a and T1b staged RCC patients.Results: The most common perioperative morbidity was blood-loss and 12% patients had ≥500 ml loss. Significantly less intraoperative blood-loss was observed in RNSS compared to ONSS with decreased blood transfusion (BT), which decreased significantly after renal-pedicle clamping prior to RCC resection. Even In perioperative period, the blood loss was significantly less in RNSS patients. However, the warm ischemia time (WIT) and hospital stay was longer in patients of RNSS compared to ONSS. The WIT was prolonged in T1b compared to T1a lesions, irrespective NSS methods.Conclusions: Although, the most common perioperative morbidity associated with NSS is blood-loss but RNSS had less perioperative morbidities compared to ONSS. The blood loss decreased significantly during intraoperative period after renal-pedicle clamping which resulted into decreased blood transfusion after NSS by either method.

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