"No clamp"- Zero Ischemia time 3-D Laparoscopic transperitoneal partial nephrectomy: A prospective evaluation
Pankaj Gupta, Sandeep Kumar, Siddharth Yadav, Y. M. Prasanth, Vijay Tyagi, Vishnu Prasad, Kumar Saurav
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Citation: Kumar A, Gupta P, Kumar S, et al. "No clamp"- Zero Ischemia time 3-D Laparoscopic transperitoneal partial nephrectomy: A prospective evaluation.
Key Words: partial nephrectomy • clampless

Ischemia is a modifiable predictor of post op decline in renal function. This potential negative effect of warm ischemia time(WIT) on renal function has led to development of techniques to minimise WIT. The role of clampless laparoscopic partial nephrectomy in renal tumors is still not established. We prospectively evaluated the feasibility, safety, efficacy and long term outcomes of 3-D laparoscopic transperitoneal clampless partial nephrectomy(LPN) in clinical T1a renal tumors.
All consecutive patients undergoing clampless 3-D LPN for a clinical T1a predominantly exophytic renal tumorsand normal contralateral kidney by a single surgeon between June 2012 and January 2018 at our institution were included .The various clinical data were recorded and analyzed. We are presenting video of one such case.
A total of 33 patients were included in the study.The mean age was 51 years with mean preoperative serum creatinine and estimated glomerular filtration rate (GFR) were 0.71 mg/dl and 75.5 ml/min/1.73 m 2 respectively. The mean tumor size was 3.2 cm. The tumor was superior polar in 15 (45.4%) patients, mesorenal 8 (24.2%) patients and inferior polar in 10 (30.3%) patients. The tumor growth pattern was cortical in 23 (69.7%) patients and corticomedullar in 10 (30.3%) patients. The mean operating time and estimated blood loss were 109.1 min and 123.7 ml respectively. The mean ischemia time was 19.1 min. There was no conversion to open. The positive surgical margins were nil. In histopathology, renal cell carcinoma was found in 93.9% and oncocytoma in 6.1% patients. The intraoperative and postoperative complications were 6% and 9% respectively and mainly Clavien 1 and 2 only. The mean estimated GFR at 4 years (71.5) was not significantly lesser than preoperative value (p = 0.71). At mean follow up of 49.3 months, there was no local or distal recurrence.
3-D Laparoscopic Clampless partial nephrectomy for small predominantly exophytic renal masses (T1a), is feasible, effective with preservation of renal function, and has acceptable complications. It offers better renal function preservation at long term follow up. Therefore wherever feasible clampless lap PN can be an option. However, it is a technically challenging procedure and should be done by surgeons of significant laparoscopic expertise.

Conflicts of interest
The authors declare no conflicts of interest.

Article history
Submitted: 18 February, 2019
Accepted: 11 April, 2019
Published online: 12 April, 2019
doi: 10.5173/ceju.2019.1847
Corresponding author
Pankaj Gupta
Conflicts of interest:  The authors declare no conflicts of interest.
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