Renal Functional and Perioperative Outcomes of Selective Versus Complete Renal Arterial Clamping During Robot-Assisted Partial Nephrectomy: Early Single-Center Experience With 39 Cases
Autor: | Junya Furukawa, Nobuyuki Hinata, Kazushi Tanaka, Hideaki Miyake, Mototsugu Muramaki, Masato Fujisawa |
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Rok vydání: | 2015 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Operative Time 030232 urology & nephrology Blood Loss Surgical Renal function Single Center Kidney Function Tests Nephrectomy Risk Assessment Perioperative Care Constriction Cohort Studies 03 medical and health sciences 0302 clinical medicine Renal Artery Robotic Surgical Procedures medicine.artery medicine Humans Renal artery Aged Retrospective Studies business.industry Retrospective cohort study Perioperative Middle Aged Kidney Neoplasms Surgery Logistic Models Treatment Outcome 030220 oncology & carcinogenesis Female business Cohort study Follow-Up Studies Glomerular Filtration Rate |
Zdroj: | Surgical innovation. 23(3) |
ISSN: | 1553-3514 |
Popis: | Objective. The objective of this study was to investigate clinical outcomes in patients undergoing selective versus conventional complete renal arterial clamping during robot-assisted partial nephrectomy (RAPN). Methods. This study included 19 patients with renal tumors who received RAPN incorporating selective arterial clamping (group 1). The renal functional as well as perioperative outcomes in group 1 were compared with those in 20 patients with renal tumors undergoing RAPN with total clamping of the renal artery (group 2) during the same period. Results. In group 1, tumor resection under selective arterial clamping could be completed in all patients without intraoperative conversion to conventional RAPN with total clamping. There were no significant differences in the tumor size, RENAL nephrometry score, or preoperative estimated glomerular filtration rate (eGFR) between groups 1 and 2. Furthermore, no significant differences were noted in the estimated blood loss, operative time, or warm ischemia time between the 2 groups. Although there was no significant difference in the rate of decrease in eGFR 4 weeks after RAPN between the 2 groups, the rate of decrease in eGFR 1 week after RAPN in group 1 was significantly lower than that in group 2. The choice of selective or total clamping was also identified as an independent predictor of a postoperative decrease in eGFR by > 10% at 1 week, but not 4 weeks, after RAPN. Conclusions. A precise segmental clamping technique is feasible and safe for performing RAPN, resulting in an improved postoperative renal function, particularly early after surgery. |
Databáze: | OpenAIRE |
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