Comparison of renal ischemic damage during laparoscopic partial nephrectomy with artery-vein and artery-only clamping.

Objective: To compare renal ischemic damage caused by artery-only (AO) and artery-vein (AV) clamping after laparoscopic partial nephrectomy.

Materials And Methods: We included 58 patients who underwent laparoscopic partial nephrectomy for nonhilar exophytic renal tumors in this study. AV clamping was used for 26 of these patients, while AO clamping was used for 32. All patients had a functional contralateral kidney. We assessed effective renal plasma flow (ERPF) by (99m)Technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scintigraphy preoperatively and at 1 week and 6 months postoperatively. In addition, we analyzed (99m)Tc-MAG3 uptake regionally in the surgically nonaffected areas.

Results: Mean tumor diameters were 3.0 cm in the AV group and 2.8 cm in the AO group. Warm ischemic time was significantly shorter in the AV group than the AO group (26.3 vs. 30.7 minutes, respectively, p=0.007). There were no differences in the estimated glomerular filtration rates or ERPF of the operated kidney between groups preoperatively or 1 week or 6 months postoperatively. The decrease in regional (99m)Tc-MAG3 uptake of the operated kidney at 1 week was correlated with warm ischemic time in both groups, being stronger in the AV group (p<0.001) than in the AO group (p=0.027). This decrease was significantly less in the AO group when the ischemic time was ≥25 minutes (88.1% vs. 102.5%, p=0.001).

Conclusions: Ischemic renal damage during laparoscopic partial nephrectomy was lessened by applying AO clamping particularly in cases with prolonged ischemic time.