ESOU18: Clamped Partial Nephrectomy

Amsterdam, The Netherlands (UroToday.com) Dr. Chlosta gave a short overview of why it is preferable to perform clamped partial nephrectomy. Minimal invasive partial nephrectomy has emerged as a viable alternative to open partial nephrectomy while lowering patient morbidity. Segmental artery clamping and off-clamp techniques have been developed to minimize the warm ischemia time, which, if prolonged, can worsen renal parenchyma function.

Nowadays, current indications for partial nephrectomy, whether open, laparoscopic or robotic, have been gradually expanded to include larger, central, hilar and infiltrating tumors. In some patients, especially those with larger and more complex tumors, the surgery results in a greater resected volume of normal-functioning nephrons. Using the clamping technique of either the main renal artery or the segmental arteries supplying the tumor region, offer the shortest resection time, with better hemostatic control, and an oncologically safe procedure.

The clamping technique allows a bloodless resection with excellent visibility, which is essential for precise tumor excision, accurate pelvicalyceal suture repair, and tight parenchymal closure. Dr. Chlosta reports that in several selected cases, where long warm ischemia time is anticipated, he also uses renal hypothermia with ice slush.

Different techniques attempting to minimize warm ischemia time are likely to continue to develop and have a role in higher risk and more complex partial nephrectomies.

Speaker: Piotr L. Chlosta, MD, PhD, DSci, FEBU Chair and Department of Urology, Jagiellonian University, Krakow, Poland

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands

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