This study describes a novel technique of selective clamping
of renal arterial branches during laparoscopic nephronsparing
surgery (LNSS) with the assistance of laparoscopic
Between March and November 2011, thirty patients (20 males
and 10 females) with small renal mass (SRM) were planned
to perform LNSS at our institution with selective clamping of
renal arterial branches using the laparoscopic ultrasonography.
The renal artery, branches and segmental arteries (the tertiary
branches) for clamping were isolated carefully using ultrasonic
scalpel and/or monopolar hook. Laparoscopic ultrasound
was utilized to direct the surgeon to identify the location, size,
depth, blood supply, and the boundary of the renal tumor. The
boundary of the renal tumor was marked by monopolar hook.
Laparoscopic bulldog were utilized to clamp the segmental
arteries associated with the tumor according to the preoperative
CTA image, direction of the segmental arteries and the location
of the tumor. Then laparoscopic ultrasound was performed
to make sure that the blood supply to the tumor was blocked
while the normal part of the kidney was spared. Bulldog clips
could be adjusted in a real time manner according to the results
of ultrasound scanning. Tumors were completely excised with
scissors. Parenchymal bleeding was controlled using argon beam
coagulation and bipolar coagulation. 2 to 3 layers of suturing
were used, of which 2-0 absorbable running suture was used
to close the collecting system or the inner part of parenchyma
while one to two 1-0 running suture for outside part of the
parenchyma. In patients with central tumors or tumors close to
the collecting system, a 5Fr ureteral catheter was inserted into
the renal pelvis before the laparoscopic procedure. Methylene
blue was instilled through the catheter to test the integrity of the
collecting system. The renal blood supply was checked again by
laparoscopic ultrasound after the bulldog clamps were removed.
The perioperative data of all cases were presented.
LNSS was successfully performed in all patients. Two cases
required conversion to clamping the main renal artery because
of intensive bleeding. The mean operative time was 130 min
(range, 100-210), mean estimated blood loss was 120 mL (range,
30-400), mean time for the clamping of renal arterial branches was 28 min (range, 15-36). There was no blood transfusion or
conversion to open surgery. The mean stay of drainage tube
was 5 days. The mean postoperative hospital stay was 7 days.
The serum Cr were not significantly different before operation
and 3 months after operation. The recovery of all patients was
Selective clamping of renal arterial branches is a new
technique to protect renal function in LNSS. The laparoscopic
ultrasonography is a very useful tool in the process of surgery.