eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Videoforum Manuscripts accepted About the journal Supplements Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank

vol. 7
Original paper

Impact of “non-clamping technique” on intra- and postoperative course after laparoscopic partial nephrectomy

Piotr Petrasz, Marcin Słojewski, Andrzej Sikorski

Videosurgery Miniinv 2012; 7 (4): 275-279
Online publish date: 2012/09/29
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Introduction: The use of kidney warm ischaemia during laparoscopic partial nephrectomy (LPN) may lead to damage of renal vessels and kidney failure. Laparoscopic partial nephrectomy done without clamping the renal pedicle is feasible and may be beneficial for the postoperative course.

Aim: To compare intra- and postoperative course in patients undergoing LPN with and without kidney warm ischaemia.

Material and methods: The material comprises 38 consecutive patients, who underwent LPN in our department during the years 2008-2009. In all cases renal vessels were identified and dissected at first, then resection of the tumour was done. Warm ischaemia was used only in case of difficulties with identification of tumour margin or with the management of bleeding. Out of 38 operations 13 were done without clamping the renal pedicle (group 1) and in the remaining 25 warm ischaemia was applied (group 2).

Results: Mean dimension of resected tumours in groups 1 and 2 was 31 mm and 33 mm respectively (p > 0.05), while parameters of intra- and postoperative course differed significantly between the groups: mean blood loss – 135 ml vs. 354 ml (p < 0.05), time of surgery – 72.6 min vs. 132.2 min (p < 0.05), postoperative drain leakage – 290 ml vs. 504 ml (p < 0.05), postoperative hospital stay – 3.1 days vs 5.3 days (p < 0.05). In all patients baseline creatinine levels were normal while after surgery creatinine elevation over the upper limit was found in groups 1 and 2 in one and in 6 patients respectively (p < 0.05).

Conclusions: Laparoscopic resection of kidney tumour without warm ischaemia is feasible and beneficial in pre- and intraoperatively selected cases. Bleeding from renal parenchyma, which requires renal pedicle clamping, may seriously deteriorate intra- and postoperative course in patients undergoing laparoscopic partial nephrectomy.

kidney cancer, laparoscopic partial nephrectomy, haemostasis, kidney warm ischaemia


. Chłosta P, Drewa T, Obarzanowski M, et al. Do we need a cosmetics effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question. Videosurgery Miniinv 2011; 6: 1-4.
Otto M, Dzwonkowski J, Grzela T, et al. Laparoscopic nephrectomy – technique and intraoperative kidney localization [Polish]. Videosurgery Miniinv 2006; 2: 65-9.
Arruabarrena A, Azagra JS, Wilmart JF, et al. Unusual complication after laparoscopic left nephrectomy for renal tumour: a case report. Videosurgery Miniinv 2010; 5: 60-4.
Ljungberg B, Cowan N, Hanbury DC, et al. Guidelines on renal cell carcinoma. In: European Association of Urology Guidelines. Arnhem 2010; 25-36.
Janetschek G. Laparoscopic partial nephrectomy for RCC: how can we avoid ischemic damage of the renal parenchyma? Eur Urol 2007; 52: 1303-5.
Gill IS, Matin SF, Desai MM, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003; 170: 64-8.
Rosales A, Salvador J, De Graeve N, et al. Clamping of renal artery in laparoscopic partial nephrectomy: an old device for a new technique. Eur Urol 2005; 47: 98-101.
Guillonneau B, Bermudez H, Gholami S, et al. Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 2003; 169: 483-6.

Simon J, Bartsch G, Finter F, et al. Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp. BJU Int 2008; 103: 805-8.

Marberger M. Renal ischaemia: not a problem in laparoscopic partial nephrectomy? BJU Int 2007; 99: 3-4.

Lane BR, Gill IS. 5-year outcomes of laparoscopic partial nephrectomy. J Urol 2007; 177: 70-4.

Permpongkosol S, Bagga HS, Romero FR, et al. Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 Renal cell carcinoma: a 5-year survival rate. J Urol 2006; 176: 1984-8.

Lin YS, Chung HU, Lin AT et al. Laparoscopic partial nephrectomy: Taipei veterans general hospital experience. J Chin Med Assoc 2010; 73: 364-8.

Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 2010; 183: 473-9.

Rozanec JJ, Ameri C, Holst P et al. Nephron-sparing surgery: our experience in open and laparoscopic approach in 254 cases. Arch Esp Urol 2010; 63: 62-9.

. Marszalek M, Meixi H, Polajnar M, et al. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009; 55: 1171-8.

Kaouk JH, Gill IS. Laparoscopic partial nephrectomy: a new horizon. Curr Opin Urol 2003; 16: 635-43.

Verhoest G, Manunta A, Bensalah K, et al. Laparoscopic partial nephrectomy with clamping of the renal parenchyma: initial experience. Eur Urol 2007; 52: 1340-6.

Simon J, De Petriconi R, Rinnab L, et al. Optimizing selective renal clamping in nephron-sparing surgery using the Nussbaum clamp. Urology 2008; 22: 22.

Harmon WJ, Kavoussi LR, Bishoff JT. Laparoscopic nephron-sparing surgery for solid renal masses using the ultrasonic shears. Urology 2000; 56: 754-9.

. Moinzadeh A, Hasan W, Spaliviero M, et al. Water jet assisted laparoscopic partial nephrectomy without hilar clamping in the calf model. J Urol 2005; 174: 317-21.

Ogan K, Jacomides L, Saboorian H, et al. Sutureless laparoscopic heminephrectomy using laser tissue soldering. J Endourol 2003; 17: 295-300.

Terai A, Ito N, Yoshimura K, et al. Laparoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors: usefulness and complications. Eur Urol 2004; 45: 744-8.

Nogueira L, Katz D, Pinochet R, et al. Comparison of gelatin matrix-thrombin sealants used during laparoscopic partial nephrectomy. BJU International 2008; 102: 1670-4.

Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010; 58: 340-5.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe