Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients w...Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.展开更多
Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal...Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN) with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI) time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p < 0.001) and intraoperative blood loss(p = 0.006),while it provided better postoperative affected renal function(p < 0.001) compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C) 2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.展开更多
文摘Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.
文摘Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN) with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI) time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p < 0.001) and intraoperative blood loss(p = 0.006),while it provided better postoperative affected renal function(p < 0.001) compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C) 2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.
