Non‐clamped partial nephrectomy: techniques and surgical outcomes

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Ishemic injury to the kidney normally occurs as a result of clamping the renal artery during a partial nephrectomy. Several years ago we described and presented the technique for partial nephrectomy without clamping the renal artery, thus avoiding renal ischemic injury. This study describes the technique and establishes the safety and efficacy of the technique. It adds a new technique to the surgical armamentarium for patients with renal tumours. OBJECTIVE • To describe our technique of partial nephrectomy (PN) without vascular clamping with perioperative and short‐term data to determine the safety, impact on renal function and oncological efficacy of this approach. PATIENTS AND METHODS • We performed a retrospective review of 952 PNs done at our institution between 1987 and 2009. Patients undergoing ex vivo PN with auto‐transplantation, patients with Von Hippel–Lindau disease and patients with incomplete follow‐up information were excluded from the analysis. • The four‐variable modification of diet in renal disease equation was used to calculate estimated glomerular filtration rate (eGFR). • The percentage change in eGFR at 1 year was compared between the two groups. RESULTS • The analysed cohort comprised 116 PNs done with renal vascular clamping (group A) and 192 PNs done without clamping (group B). The median tumour size was slightly larger in group B than in group A (3.0 vs 2.8 cm, P = 0.002). • There was no difference in preoperative eGFR (P = 0.304) or the prevalence of solitary kidney (P = 0.69). • Median estimated blood loss was 300 mL higher in the unclamped group (P