Application of a Vasculature Model and Standardization of the Renal Hilar Approach in Laparoscopic Partial Nephrectomy for Precise Segmental Artery Clamping

作者：Shao, Pengfei; Tang, Lijun; Li, Pu; Xu, Yi; Qin, Chao; Cao, Qiang; Ju, Xiaobing; Meng, Xiaoxin; Lv, Qiang; Li, Jie; Zhang, Wei; Yin, Changjun^*

来源：European Urology, 2013, 63(6): 1072-1081.

DOI：10.1016/j.eururo.2012.10.017

• Angiography
• Laparoscopy
• Model
• Partial nephrectomy
• Segmental renal artery
• Vasculature

Background: Clamping the segmental renal artery instead of the main renal artery during nephron-sparing surgery is a promising technique to decrease warm ischemia injury. Understanding vasculature characteristics and adopting an appropriate hilar approach to segmental arteries are essential to the technique. @@@ Objective: To study the role of the vasculature model and to standardize the renal hilar approach in segmental renal artery dissection during laparoscopic partial nephrectomy (LPN). @@@ Design, setting, and participants: A retrospective analysis of a consecutive series of 82 patients who underwent LPN with a precise clamping technique from December 2009 to June 2011 with a mean follow-up of 20 mo. @@@ Surgical procedure: Three-dimensional dynamic renal vascular models were established based on dual-source computed tomographic angiography. Clamping number, clamping position, and a different hilar approach accessing target segmental arteries were determined preoperatively. Target arteries were dissected and clamped based on the model. Tumor excision and renorrhaphy were performed under regional parenchymal ischemia. @@@ Outcome measurements and statistical analysis: Renal vascular characteristics and surgical outcomes were analyzed. The outcomes among different surgical approaches were compared using one-way analysis of variance test or Fisher exact test. @@@ Results and limitations: All surgeries were performed successfully without converting to main renal artery clamping or radical nephrectomy. The median operative time was 90 min, and the mean clamping time was 24 min. The median estimated blood loss (EBL) was 200 ml, and six patients received blood transfusions. Five patients had hematuria without any intervention. One patient had a postoperative hemorrhage and received selective embolization intervention. Statistical analysis showed that appropriate surgical approaches chosen from the models led to comparable operative times, EBL, and complication rates. The limitation of the study lies on its retrospective feature. @@@ Conclusions: A renal vasculature model provides effective orientation for a precise clamping technique. A standardized hilar approach based on the model optimizes the surgical procedure and leads to satisfactory surgical outcomes.

• 出版日期2013-6
• 单位南京医科大学