Factors Influencing the Feasibility of Segmental Artery Clamping During Retroperitoneal Laparoscopic Partial Nephrectomy.

Objective: To investigate factors that may predict successful precise segmental artery clamping during retroperitoneal laparoscopic partial nephrectomy (LPN) for treatment of T1 kidney tumor.

Patients And Methods: Patients with clinical T1 tumors (n = 248) who received retroperitoneal LPN from June 2012 through February 2018 were reviewed, including demographics and clinical features. However, only 225 cases (90.7%) were available to analyze. Precise segmental artery clamping was the first clamping method selected during the LPN. If unsuccessful, conversion to main renal artery clamping was conducted. The perioperative features and functional outcomes of the 2 clamping types were compared.

Results: Of the 225 patients, 190 procedures were effectively performed using segmental artery clamping, while 35 (15.6%) were converted to main renal artery clamping. None were converted to open surgery. Clamping the main renal artery was associated with longer operative time, less estimated blood loss, and higher glomerular filtration rate reduction, compared with successful segmental artery clamping. Univariable analyses determined that the following features affected the feasibility of segmental artery clamping: gender; hypertension; tumor location, growth pattern, and targeted artery number; R.E.N.A.L. nephrometry score (RNS); and Mayo adhesive probability (MAP) score. The multivariable analyses indicated that male gender, high RNS, and elevated MAP score were independent factors lowering the viability of segmental artery clamping.

Conclusion: LPN with segmental artery clamping is generally safe for removing T1 kidney tumors. Extra cognizance may be required in men and cases with high RNS or MAP score.