Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: Impact upon renal function in the setting of a solitary kidney in a porcine model

Brian M. Benway, Geneva Baca, Sam B. Bhayani, Nitin A Das, Matthew D. Katz, Dilmer L. Diaz, Keegan L. Maxwell, Khalid H. Badwan, Michael R. Talcott, Helen Liapis, Jose M. Cabello, Ramakrishna Venkatesh, Robert S. Figenshau

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week. Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60- and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

Original languageEnglish (US)
Pages (from-to)1127-1133
Number of pages7
JournalJournal of Endourology
Volume23
Issue number7
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

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Nephrectomy
Constriction
Swine
Kidney
Renal Insufficiency
Blood Vessels
Creatinine
Warm Ischemia
Blood Urea Nitrogen
Intraoperative Complications
Standard of Care
Serum

ASJC Scopus subject areas

  • Urology

Cite this

Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy : Impact upon renal function in the setting of a solitary kidney in a porcine model. / Benway, Brian M.; Baca, Geneva; Bhayani, Sam B.; Das, Nitin A; Katz, Matthew D.; Diaz, Dilmer L.; Maxwell, Keegan L.; Badwan, Khalid H.; Talcott, Michael R.; Liapis, Helen; Cabello, Jose M.; Venkatesh, Ramakrishna; Figenshau, Robert S.

In: Journal of Endourology, Vol. 23, No. 7, 01.07.2009, p. 1127-1133.

Research output: Contribution to journalArticle

Benway, BM, Baca, G, Bhayani, SB, Das, NA, Katz, MD, Diaz, DL, Maxwell, KL, Badwan, KH, Talcott, MR, Liapis, H, Cabello, JM, Venkatesh, R & Figenshau, RS 2009, 'Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: Impact upon renal function in the setting of a solitary kidney in a porcine model', Journal of Endourology, vol. 23, no. 7, pp. 1127-1133. https://doi.org/10.1089/end.2008.0605
Benway, Brian M. ; Baca, Geneva ; Bhayani, Sam B. ; Das, Nitin A ; Katz, Matthew D. ; Diaz, Dilmer L. ; Maxwell, Keegan L. ; Badwan, Khalid H. ; Talcott, Michael R. ; Liapis, Helen ; Cabello, Jose M. ; Venkatesh, Ramakrishna ; Figenshau, Robert S. / Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy : Impact upon renal function in the setting of a solitary kidney in a porcine model. In: Journal of Endourology. 2009 ; Vol. 23, No. 7. pp. 1127-1133.
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T1 - Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy

T2 - Impact upon renal function in the setting of a solitary kidney in a porcine model

AU - Benway, Brian M.

AU - Baca, Geneva

AU - Bhayani, Sam B.

AU - Das, Nitin A

AU - Katz, Matthew D.

AU - Diaz, Dilmer L.

AU - Maxwell, Keegan L.

AU - Badwan, Khalid H.

AU - Talcott, Michael R.

AU - Liapis, Helen

AU - Cabello, Jose M.

AU - Venkatesh, Ramakrishna

AU - Figenshau, Robert S.

PY - 2009/7/1

Y1 - 2009/7/1

N2 - Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week. Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60- and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

AB - Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week. Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60- and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

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