Laparoscopic partial nephrectomy using local ischemia

Abstract Oncological outcomes of laparoscopic partial nephrectomy are no worse than those after open sparing operation for kidney cancer. However, laparoscopic procedures are accompanied by a longer warm ischemia. In order to reduce the ischemic injury, local ischemia by isolation and temporary clamping of the individual branches of the renal artery was used. From January 2009 to June 2012, 60 laparoscopic partial nephrectomies were performed in the clinic, including 34 resections with temporary clipping of renal artery and 26 resections with temporary clipping of secondary and tertiary segmental and subsegmental branches. Functions of affected kidney were evaluated before and after surgery in both groups of patients. At 3 months after surgery, significantly lower decline of the function of affected kidney was observed in patients who underwent resection with the use of local ischemia compared with patients who received the intervention accompanied by a temporary clamping the renal artery. Partial nephrectomy using local ischemia can significantly expand the indications for laparoscopic and retroperitoneoscopic sparing operation for renal cell cancer.