Minimally invasive partial nephrectomy without hilar clamping in patiens with solitary kidney

==inizio abstract==

Objective: Partial nephrectomy (PN) without vascular clamping may reduce the risk of acute renal failure (ARF) and chronic kidney disease (CKD). Therefore we evaluated feasibility, safety, functional and oncologic outcomes of 12 patients with solitary kidney who underwent laparoscopic PN without hilar clamping.

METHODS: Between May 2005 and June 2012, 7 laparoscopic partial nephrectomies (LPN) and 5 robotic assisted partial nephrectomies (RAPN) were performed for renal tumors in solitary kidney. Data, including tumor characteristics, surgery details, complications, postoperative renal function and oncological outcomes, were collected in a prospective maintained database. Five patients underwent LPN after preoperative superselective transarterial embolization, 2 patients with low nephrometry score underwent“zero ischemia” sutureless LPN and the last 5 patients underwent “ zero ischemia” RAPN with controlled hypotension.
RESULTS: All cases were successfully completed. No early and late complications occurred. Median tumor size was 3.1cm. Median blood loss was 160 cc (50-350).
No patients required intraoperative transfusions. Three patients (25%) required transfusion postoperatively. No major complications occurred.
Histopathologic evaluations revealed clear cell renal cell carcinoma in 9 patients (75 %) and oncocytomas in 3 patients(25%). All margins were negative.
Median pre and postoperative serum creatinine levels were 1.29 mg/dl and 1.6 mg/dl, respectively. Postoperative dialysis wasn’t necessary in any patient.
Two (16.6 %) patients had preoperative CKD, while seven (58.3 %) of them developed CKD postoperatively.
At median follow-up of 48 months three patients had local recurrence, two of them at 24 months and one patient 11months after surgery. Two patients with local recurrence experienced distant metastasis at 11 and 45 months, respectively. Four year cancer specific survival and overall survival were 100% and 91.7%, respectively.

CONCLUSION: In patients with solitary kidney minimally invasive PN without hilar clamping is feasible. All procedures were safely completed with satisfactory oncologic and functional outcomes.

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