„Zero ischaemia” laparoscopic partial nephrectomy

DOI: 10.22591/magyurol.2018.2.pusztaics.60

Authors:
Pusztai Csaba dr., Sarlós Donát Péter dr.,Horváth Anna Csenge dr., Szántó Árpád dr.
Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)

Summary

Objectives: Partial nephrectomy has become the gold standard of surgical care for T1N0M0 stage renal tumours. Functional outcome of surgery depends on many factors, of which ischaemia time is the only fully modifiable factor. In this sense, zero ischemia represents the reachable technical optimum.
Materials and methods: Patient, tumour, operative and follow-up data related to laparoscopic partial nephrectomies were recorded prospectively in an institute database. The study group was formed by patients without hilar compression. For each case of the study group, a computer algorithm was used to select a control case from non-zero ischaemia surgeries that fitted as good as possible in the significant attributes (control group).
Results: There was no significant difference between the study and control groups in terms of transfusion rate, length of hospital stay, positive surgical margins, and frequency of complications. In the zero ischaemia group, the operative time was significantly shorter. Mean postoperative renal function loss was not significantly lower than in the control group, but there was a fewer number of patients with significant renal function deterioration (>30%).
Conclusion: Our study proved that zero ischemia is a feasible and safe method for laparoscopic partial nephrectomies. The operative time is shorter and a slightly more intraoperative blood loss is compensated by the low incidence of postoperative haemorrhage. Using this technique, the proportion of patients with surgically induced severe renal impairment can be reduced.

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