CU 33. Laparoscopic nephron - sparing surgery with highly selective clamping of renal arterial branches using the laparoscopic ultrasonography

Introduction: To describe a clamping technique of renal arterial branches during laparoscopic nephron-sparing surgery (LNSS) using the laparoscopic ultrasonography.

Methods: Between March and November 2011, thirty patients (20 males and 10 females) with small renal mass (SRM) were planed to underwent LNSS at our institution with highly selective clamping of renal arterial branches using the laparoscopic ultrasonography. The laparoscopic ultrasonography was used to detect the location, size, and blood supply (before and after clamping) of the tumor. The perioperative data of all surgeries were presented.

Results: LNSS was successfully performed in twenty-nine patients. Two cases required conversion to clamping the main renal artery because of intraoperative 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. sCr and eGFR were not significant different between pre- and post-operation. The recovery of all patients was uneventful.

Conclusions: Highly selective clamping of renal arterial branches is a new technique to protect renal function in LNSS, which can be performed safely and efficiently with a combination of the laparoscopic ultrasonography. Further studies and longer follow-up are necessary to determine the long-term efficacy of this novel technique.