Achieving zero ischemia in minimally invasive partial nephrectomy surgery

Int J Surg. 2015 Jun:18:48-54. doi: 10.1016/j.ijsu.2015.04.046. Epub 2015 Apr 17.

Abstract

Widespread application of the minimally invasive partial nephrectomy (MIPN) techniques like laparoscopic and robotic partial nephrectomy, has been limited by concerns about prolonged warm ischemia. So techniques aiming at performing have been actively explored. A systemic review of literatures on the MIPN without hilar clamping was performed and related methods were summarized. There are mainly seven methods including selective/segmental renal artery clamping technique, selective renal parenchymal clamping technique, targeted renal blood flow interruption technique, laser supported MIPN, radio frequency assisted MIPN, hydro-jet assisted MIPN, and sequential preplaced suture renorrhaphy technique that have been undergoing enthusiastic investigation for achieving MINP without hilar clamping. All of these emerging techniques represent the exploring work to achieve a zero ischemia MIPN for small renal tumors of different characteristics. Though not perfect for any of the technique, they deserve a further assessment during their future experimental and clinical applications.

Keywords: Energy ablative surgery; Minimal invasive partial nephrectomy; Renal function protection; Robotic partial nephrectomy; Zero ischemia.

Publication types

  • Review

MeSH terms

  • Catheter Ablation
  • Constriction
  • Humans
  • Laparoscopy
  • Lasers
  • Minimally Invasive Surgical Procedures / methods*
  • Nephrectomy / methods*
  • Postoperative Hemorrhage / prevention & control*
  • Renal Artery
  • Robotics
  • Suture Techniques