Laparoscopic off-clamp partial nephrectomy using soft coagulation

OBJECTIVE - To assess the effectiveness of soft coagulation in off-clamp laparoscopic partial nephrectomy.

METHODS - A total of 32 patients with renal tumors underwent laparoscopic partial nephrectomy with off-clamp using soft coagulation between May 2012 and September 2013. Tumor resection was carried out using a combination of bipolar forceps and a ball electrode using the soft coagulation system without hilar clamping.

The outcomes of these patients were compared with those of 30 patients treated with hilar clamping.

RESULTS - This off-clamp procedure was successfully completed in 31 cases. No significant differences were observed in the mean age (60 vs 61 years), sex (male/female; 25/7 vs 20/10), mean RENAL nephrometry score (5.7 vs 5.8), mean body mass index (24.4 vs 23) or tumor size (15 mm vs 16 mm) between the two groups. No significant differences were noted in positive surgical margins (0 vs 0) or blood loss (104 vs 115 cc) as well.

In contrast, a significant difference was noted in the total operative time (278 vs 238 min). Serum creatinine percentage changes at 3 months were 6.4 versus 7.3% in the off-clamp and hilum-clamp groups, respectively, which were not significantly different.

CONCLUSIONS - Off-clamp laparoscopic partial nephrectomy can be safely carried out by using a soft coagulation technique.

Int J Urol. 2015 Aug;22(8):731-4. doi: 10.1111/iju.12808. Epub 2015 May 18.

Hongo F1, Kawauchi A2, Ueda T1, Fujihara-Iwata A1, Nakamura T1, Naya Y1, Kamoi K1, Okihara K1, Miki T1.

1 Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
2 Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan.