Simplified Zero Ischemia in Robot Assisted Partial Nephrectomy: Initial Yonsei Experience

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the safety and feasibility of a simplified zero ischemia technique using kidney donor computed tomographic (CT) angiography and conventional laparoscopic bulldog clamps.
Materials and Methods: We conducted a review of seven robot-assisted partial nephrectomies (RAPNs) performed by a single surgeon from January 2012 to May 2012. Using a simplified protocol of 3-dimentional reconstruction, tertiary arterial branches supplying the tumor were selectively clamped prior to resection. We used conventional laparoscopic bulldog clamps instead of microsurgical vessel clamps. The patients’ demographic information, perioperative outcomes, pathologic outcomes and pre- and postoperative renal functions up to 3 months follow-up were analyzed.
Results: RAPN were successfully performed for seven complex renal hilar tumors.
There were no significant differences in the total operation time, estimated blood loss or postoperative outcomes compared with published literature on standard RAPN.
Negative surgical margins were reported in all cases.
Conclusions: We presented a simplified-zero ischemia technique using kidney Donor CT angiography and conventional laparoscopic bulldog clamps. We have also demonstrated its safety and feasibility in patients with complex renal hilar tumors. This modified technique can be easily adopted by most surgeons who are currently performing RAPN.

참고문헌 (Reference)

1 Kutikov A, "nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth" 182 : 844-853, 2009

2 Abreu AL, "Zero-ischaemia robotic partial nephrectomy (RPN) for hilar tumours" 108 (108): 948-954, 2011

3 Gill IS, "Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique" 59 : 128-134, 2011

4 Benway BM, "Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes" 55 : 592-599, 2009

5 Rogers CG, "Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis" 180 : 2353-2356, 2008

6 Ljungberg B, "Renal cell carcinoma guideline" 51 : 1502-1510, 2007

7 Ficarra V, "Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery" 56 : 786-793, 2009

8 Joniau S, "Outcome of nephron-sparing surgery for T1b renal cell carcinoma" 103 : 1344-1348, 2009

9 Antonelli A, "Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm" 74 : 173-179, 2007

10 Uzzo RG, "Nephron sparing surgery for renal tumors: indications, techniques and outcomes" 166 : 6-18, 2001

11 Peycelon M, "Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm" 181 : 35-41, 2009

12 Puppo P, "Long term results of excision of small renal cancer surrounded by a minimal layer of grossly normal parenchyma: review of 94 cases" 46 : 477-481, 2004

13 Jeong W, "Laparoscopic partial nephrectomy versus robot-assisted laparoscopic partial nephrectomy" 23 : 1457-1460, 2009

14 Simmons MN, "Kidney tumor location measurement using the C index method" 183 : 1708-1713, 2010

15 Funahashi Y, "Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney" 55 : 209-215, 2009

16 Simmons MN, "Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury" 187 : 1667-1673, 2012

17 Sutherland SE, "Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter?" 167 : 61-64, 2002

18 Ng CK, "Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy" 61 : 67-74, 2012