Open Partial Nephrectomy without Ischemia; Case Series

Aims: Renal vascular clamping during partial nephrectomy can lead to renal ischemia and kidney damage due to reperfusion injuries, but a surgical technique without any ischemia can eliminate such unwanted effects on kidney function. The present study aimed to demonstrate the feasibility of partial nephrectomy in conditions where the renal artery is ready to be clamped. Patient Information: In this case series study, ۲۴ eligible patients with small solitary renal masses were included in the study between ۲۰۱۳ and ۲۰۱۸. The option of surgery was open partial nephrectomy. During the time corresponding to the hilar clamping in standard techniques, the renal artery was exposed and ready for clamping if needed, and in this situation, resecting the mass was carried out. Findings: The mean tumor resection time was ۲۲.۰۸±۲.۵۰ minutes, and the mean procedure time was ۹۲.۰۰±۴.۶۰ minutes. Clear cell renal cell carcinoma was seen in ۱۹ patients, papillary renal cell carcinoma in ۳, and oncocytoma in ۲ patients. There was no positive surgical margin in specimens with cancer. Lower pole, mid zone, and upper pole masses were observed in ۱۴, ۲, and ۸ cases, respectively. Conclusion: Although this technique can potentially be a dangerous procedure, in a situation in which the renal artery is well exposed and ready to be controlled, especially when the tumor is in Polar Regions, the mass resection can be safely done without any type of ischemia. Therefore, this procedure can be suggested as a viable one in comparison with other related procedures.

Keywords:

Kidney Neoplasm , Nephrectomy , Ischemia