Determining the best warm ischemic time for patients undergoing partial nephrectomy for renal cancer

Introduction: The relative impact of preoperative and perioperative variables on renal function following partial nephrectomy (PN) is controversial. To further investigate, we assess the effects of tumour complexity, warm ischemic time (WIT), and volume of resected renal parenchyma on ipsilateral renal function (IRF) outcomes following minimally invasive PN.Methods: Of patients who underwent laparoscopic or roboticassisted PN between 2002 and 2011 at our institution, 99 met our inclusion criteria. The effects of preoperative tumour complexity (using RENAL nephrometry score), perioperative WIT, and pathological tumour volumes on ipsilateral renal function preservation (%IRF) were analyzed. %IRF was defined as the proportion of postoperative to preoperative ipsilateral renal function calculated using MAG3 nuclear renography.Results: Increasing RENAL nephrometry score (RNS) and WIT were independently predictive of inferior %IRF at 6‒12-week postoperative followup in univariate and multivariate analyses. Of RNS properties, masses that were endophytic, near the collecting system, or central in location were associated with inferior %IRF, with nearness to collecting system as the strongest predictor; however, RNS was no longer predictive of %IRF in cases requiring more than 30 minutes of WIT.Conclusions: In renal masses amenable to resection by minimally invasive PN, longer WIT was the most important predictor of inferior %IRF. Although increasing RNS score influenced %IRF, the overall clinical significance of RNS is limited and should not influence operative decision-making in efforts to preserve renal function. Furthermore, small volumes of renal parenchyma can be safely resected without impairment of long-term IRF.

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Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

Urology & Nephrology Open Access Journal ◽

10.15406/unoaj.2020.08.00298 ◽

2020 ◽

Vol 8 (6) ◽

pp. 161-166

Author(s):

Krishnendu Biswas ◽

Rohan S Batra ◽

Abhishek G Singh ◽

Arvind P Ganpule ◽

Ravindra B Sabnis ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Tumour Size ◽

Robotic Partial Nephrectomy ◽

Ischemic Time ◽

Warm Ischemic Time ◽

Nephrometry Score ◽

Significant Difference ◽

One Year

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

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93 Change of differential renal function after laparoscopic and robot-assisted partial nephrectomy with short warm ischemic time

European Urology Supplements ◽

10.1016/s1569-9056(14)60094-4 ◽

2014 ◽

Vol 13 (1) ◽

pp. e93-e93a

Author(s):

K.S. Kim ◽

S.W. Choi ◽

Y.S. Choi ◽

W.J. Bae ◽

H.J. Cho ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Robot Assisted ◽

Ischemic Time ◽

Warm Ischemic Time ◽

Differential Renal Function

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Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

Journal of Clinical Medicine ◽

10.3390/jcm9113658 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3658

Author(s):

Ching-Chia Li ◽

Tsu-Ming Chien ◽

Shu-Pin Huang ◽

Hsin-Chih Yeh ◽

Hsiang-Ying Lee ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Cancer ◽

Operation Time ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Single Site ◽

Renal Tumors ◽

Ischemic Time ◽

Intracorporeal Suturing ◽

Ischemia Time

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.

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