The Application of R.E.N.A.L. Nephrometry Score In Laparoscopic Partial Nephrectomy With Zero Ischemia And Sutureless

Background: To evaluate the application of R.E.N.A.L. nephrometry score (RNS) in laparoscopic partial nephrectomy (LPN) with zero ischemia and sutureless surgery, and to explore the efficacy and safety of zero ischemia and seamless LPN in the treatment of renal cell carcinoma.Methods: The clinical data of 67 patients with renal cell carcinoma treated by LPN in the affiliated Hospital of Guizhou Medical University from January 2016 to July 2020 were analyzed retrospectively. The patients were divided into renal artery occlusion group (n=31) and non-occlusion group (n=36). All cases were divided according to their RNS (low, moderate, and high), and the perioperative condition, postoperative complications, postoperative recovery and changes of renal function in the two groups were analyzed.Results: According to the RNS, all cases were classified in low-complex. Both groups successfully completed the operation without operative complications. Compared with the renal artery occlusion group, the non-occlusion group had a shorter operation time (35.51±20.48 min), shorter hospital stay (6.72±4.39 d), and no significant difference in intraoperative blood loss(50.39±30.19 ml). During the 6-month follow-up, the creatinine value of the renal function in the non-occlusion group (78.47±10.98μmol/L) was lower than that in the occlusion group(98.21±8.06μmol/L).Conclusion: Zero-ischemia sutureless LPN technique can effectively reduce the time of ischemia and avoid renal ischemia-reperfusion injury. This surgical technique may be a feasible surgical method for the treatment of low RNS renal cell carcinoma.

Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time

Purpose To describe a patient with acute renal artery occlusion who underwent successful revascularization procedure after experiencing a protracted ischemic period, which resulted in successful retrieval of renal function. Case report A 58-year-old male with a history of left renal artery stenosis and stent graft placement presented with symptoms of chest pain, shortness of breath, and flank pain. The patient was admitted to the Intensive Care Unit with the diagnosis of multiorgan failure and subsequent anuria that led to the initiation of hemodialysis. Computed tomography angiography demonstrated an aortic occlusion along with bilateral proximal renal artery occlusion with reconstitution of the mid to distal renal arteries via collateralization. The patient underwent angioplasty with bilateral renal artery stent-graft placement and successful revascularization of proximal renal arteries. Post-operatively, his renal function and urine output improved, and the patient was able to be weaned off hemodialysis along with the benefit of concurrent amelioration of his renovascular hypertension. Conclusion For select patients with renal artery occlusion, revascularization of the renal arteries may result in dialysis independence and stabilization of renovascular hypertension, despite prolonged time of ischemia.