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Non Clamping Partial Nephrectomy
William C. Faust, MD1, Patrick Kenney, MD2, John Libertino, MD1.
1Lahey Clinic, Burlington, MA, USA, 2MD Anderson Cancer Center, Burlington, MA, USA.
BACKGROUND:
When technically feasible, Nephron Sparing Surgery (NSS) is considered standard of care for removal of most T1a lesions in Renal Cell Carcinoma. It has been shown to have similar oncologic outcomes while providing the benefit of preserving renal function. Traditional approaches to NSS involve occlusion of the hilar vessels, and removal of the tumor using either warm or cold ischemia. We have developed a novel technique to perform NSS without the use of vascular occlusion.
METHODS:
The technique for non-clamping partial nephrectomy includes the use of intraoperative ultrasound to delineate the extent of the tumor and demarcate the line of resection. Needle point bovie electrocautery is used to create an incision around the periphery of the tumor then spatulas are used identify small intrarenal arteries that are grasped with Gerald forceps and coagulated. Larger vessels are ligated in continuity. Once complete, the bolster sutures are used to reapproximate the parenchyma to create compression.
RESULTS:
We have found that patients who have undergone non-clamping partial nephrectomy have similar long term oncologic outcomes while having improved long term renal function.
CONCLUSIONS:
Non-clamping partial nephrectomy can be safely perfomed for most T1a lesions. Even challenging lesions may be amenable to this approach.
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