Hydro-Jet-assisted laparoscopic partial nephrectomy with no renal arterial clamping: a preliminary study in a single center.

Objective: To describe our experience with Hydro-Jet-assisted laparoscopic partial nephrectomy (LPN) with no renal arterial clamping in 35 patients with renal cell carcinoma.

Methods: Hydro-Jet technique was used to incise the renal parenchyma, dissect the intrarenal vessels and collecting system during the LPN procedure in 35 patients with renal cell carcinoma. Patient demographics, tumor characteristics, perioperative data and renal function parameters were collected prospectively. All procedures were performed by a single surgeon.

Results: All LPN procedures were completed without conversion to open surgery or nephrectomy. The mean operation duration was 113.6 min (range 72-202). The mean blood loss was 149.4 ml (range 30-530). No Clavien ≥3 complication was observed in any patient. There was no significant difference between the preoperative GFR of the affected kidney and GFR at 3 months postoperation (54.9 vs. 54.2 ml/min, p = 0.063). Clear cell carcinoma was confirmed histopathologically in 30 patients (85.7%), papillary renal cell carcinoma in four patients (11.4%) and chromophobe renal cell carcinoma in one patient (2.9%), all with negative surgical margins. No tumor recrudescence was observed during the mean follow-up period of 6.32 months (range 3-9 months).

Conclusion: The Hydro-Jet-assisted no-clamping LPN technique is safe, feasible and effective in selected cases. It could avoid intraoperative ischemia-reperfusion injury to the kidney. The learning curve should be further discussed, and its feasibility with larger and more complex endophytic tumors should be further explored in future controlled clinical trials with larger samples and long-term follow-up periods.