Artery-Only Occlusion May Provide Superior Renal Preservation During Laparoscopic Partial Nephrectomy

Main Category: Urology / Nephrology
Article Date: 24 Nov 2008 - 1:00 PDT

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UroToday.com - Contrary to the animal data provided by these same investigators (which showed no benefit to artery-only vs. complete hilar clamping), their clinical study of 25 artery-only patients matched to a cohort of 53 patients who underwent complete hilar clamping showed a statistically significant acute postoperative day one drop in creatinine clearance in the hilar clamped group, despite similar lengths of warm ischemia time. This was true for patients with either normal renal function or mild renal insufficiency preoperatively.

At last follow-up, averaging 22 months in the artery-only group, and 10 months in the hilar clamped group, a statistically significant drop from the preoperative creatinine clearance persisted in the artery only group (clearance of 77), while there was no significant change in the hilar clamped group (clearance of 93). The artery-only group did have a 20 minute longer operative time and an extra 80 cc of blood loss but neither was statistically significant.

Bottom Line: For patients undergoing a partial nephrectomy with the need for warm ischemia, artery-only clamping is recommended. The "cat-bird" study has yet to come - specifically a single blind prospective study of the two approaches.

Gong EM, Zorn KC, Orvieto MA, Lucioni A, Msezane LP, Shalhav AL
Urology. 2008 Oct;72(4):843-6.
doi: 10.1016/j.urology.2008.05.020

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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