Temporary occlusion of the renal artery may be necessary for the extensive kidney operation. Performance of kidney operation requires an understanding of renal responses to warm ischemia and available methods of protecting the kidney while arterial occlusion. To minimize the loss of kidney function cooling of the organ is mandatory. The cooling can be accomplished either by perfusion with cold solution or by in situ surface cooling During the last 41 months, we performed renal surgery using hypothermia technique with good results in l5 patients.
Humans ; Hypothermia* ; Kidney ; Perfusion ; Renal Artery ; Warm Ischemia

PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.
Amputation ; Cold Ischemia ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Intention ; Replantation ; Warm Ischemia

PURPOSE: To determine the feasibility and safety of robotic partial nephrectomy (RPN), we compared the operative outcomes of patients who had undergone RPN with those of patients who had undergone laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: Between February 2009 and June 2010, 13 patients underwent transperitoneal RPN (group 1) and 14 patients underwent transperitoneal LPN (group 2) by a single surgeon. The operative outcomes of the 2 groups were compared by using Mann-Whitney U and Fisher's exact tests. RESULTS: All cases were completed successfully without conversion to open surgery. The mean operative time was 153.2+/-22.3 and 117.5+/-32.0 minutes in groups 1 and 2, respectively (p=0.003). The mean robotic console time of group 1 was 101.2+/-21.5 minutes, and the mean laparoscopic time of group 2 was 86.8+/-32.3 minutes (p=0.139). The mean warm ischemic time was 35.3+/-8.5 minutes and 36.4+/-6.8 minutes in groups 1 and 2, respectively (p=0.823). The mean estimated blood loss was 283.6+/-113.5 ml and 264.1+/-163.7 ml (p=0.382), respectively. The mean length of hospital stay was 6.1 and 5.3 days (p=0.290), respectively. The mean tumor size was 2.7+/-1.2 cm and 2.0+/-1.2 cm (p=0.035), respectively. The surgical margins were negative in all cases. CONCLUSIONS: Although the operative time of RPN was longer than that of LPN, there were no significant differences in operative outcomes including robotic console time and laparoscopic time between the procedures.
Conversion to Open Surgery ; Humans ; Kidney Neoplasms ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Warm Ischemia

PURPOSE: To evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors. MATERIALS AND METHODS: From March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months. RESULTS: The mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2). CONCLUSIONS: Renal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.
Diet ; Glomerular Filtration Rate ; Humans ; Immunotherapy ; Kidney ; Laparoscopy ; Nephrectomy ; Renal Insufficiency, Chronic ; Retrospective Studies ; Warm Ischemia

PURPOSE: Preoperative aspects and dimensions used for an anatomical (PADUA) classification is useful to predict perioperative complications and warm ischemia time. However, it remains uncertain whether PADUA classification can predict intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). We evaluate whether PADUA classification parameters can predict conversion to RN during PN. MATERIALS AND METHODS: We retrospectively assessed data of 593 patients who underwent open PN and robotic PN for renal tumors by a single surgeon at a single tertiary center between December 2003 and September 2017. Intraoperative conversion to RN was performed in 17 of 593 patients who initially underwent PN. We evaluated the factors influencing the surgical modalities including PN and radical conversion cases. Then, the factors significantly associated with conversion to RN were further analyzed. RESULTS: There were no significant differences between the 2 groups in age, longitudinal location, exophytic rate, and rim or face locations of renal masses. Renal sinus involvement, urinary collecting system involvement, and renal mass size were variables that predicted radical conversion, using univariate analysis. Renal sinus involvement (odds ratio [OR], 9.075; p=0.049) and urinary collecting system involvement (OR, 3.944; p=0.029) were independent predictors of intraoperative radical conversion, using multivariate analysis. CONCLUSIONS: The PADUA classification is a useful tool to predict intraoperative conversion from PN to RN. Renal sinus involvement and urinary collecting system involvement are the best predictors of intraoperative conversion from PN to RN.
Classification ; Factor Analysis, Statistical* ; Humans ; Multivariate Analysis ; Nephrectomy* ; Retrospective Studies ; Surgical Procedures, Operative ; Warm Ischemia

PURPOSE: We introduce our transient vascular occlusion technique that uses a vessel loop and Hem-o-Lok clips in laparoscopic partial nephrectomy. MATERIALS AND METHODS: From March 2009 to March 2011, 15 consecutive patients underwent laparoscopic partial nephrectomy. All operations were performed by a single surgeon using the transperitoneal approach. The transient vascular occlusion technique was as follows. After dissection of renal vessels, the vessel loop is winded twice around the vessel. Both distal portions of the vessel loop are clipped with a Hem-o-Lok clip. When vascular occlusion is required, an additional Hem-o-Lok clip is applied to the proximal portion of the vessel loop by pulling the distal portion. When no longer needed, the vessel loop is simply cut. RESULTS: All operations were performed successfully without open conversion. The mean tumor size was 2.5 cm (range, 1.1-3.5 cm). There were 8 cases of renal cell carcinoma and 7 cases of angiomyolipoma. All cases of renal cell carcinoma had a negative surgical margin. The mean operative time and the mean warm ischemic time were 176 minutes (range, 104-283 minutes) and 26.1 minutes (range, 18-34 minutes), respectively. There were no cases of uncontrollable intraoperative bleeding and no postoperative complications. CONCLUSIONS: The transient vascular occlusion technique with a vessel loop and Hem-o-Lok clips is a feasible technique with simplicity, effectiveness, and safety. It is an acceptable alternative to standard vascular occlusion techniques, such as laparoscopic bulldog or Satinsky clamps.
Angiomyolipoma ; Carcinoma, Renal Cell ; Glycosaminoglycans ; Hemorrhage ; Humans ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy ; Operative Time ; Warm Ischemia ; Wind

BACKGROUND/AIMS: To assess the preventive effect of simple in situ cooling on ischemic injury in human livers. METHODS: The study consisted of 22 patients who were to undergo liver resection (right lobectomy, n=6, left lobectomy, n=3, posterior segmentectomy, n=1, and extended cholecystectomy, n=1, in each group). All but 2 had normal remnant livers and all patients were randomised to undergo either warm ischemia or in situ cooling (n=11 in each group). RESULTS: The mean (SD) occlusion time was 53.7 (5.8) minutes for the warm ischemia group and 52.7(3.1) for the in situ cooling group. After in situ cooling, the state of the liver as indicated by serum alanine aminotransferase activity (ALT) and prothrombin time had improved substantially. Mean (SD) ALT activity was 483 (192) U/L in the warm ischemia group compared with 288 (157) in the in situ cooling group (p<0.02) on the first postoperative day. The respective figures for prothrombin time (%) were 58(23) compared with 77 (13), (p < 0.05). CONCLUSION: In situ cooling lessened the amount of ischemic damage done to the liver during hepatectomy compared to treatment with that of warm ischemia.
Alanine Transaminase ; Cholecystectomy ; Hepatectomy* ; Humans* ; Hypothermia* ; Liver* ; Mastectomy, Segmental ; Prothrombin Time ; Warm Ischemia

PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.
Decision Making ; Follow-Up Studies ; Kidney ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy ; Recurrence ; Warm Ischemia

PURPOSE: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping. MATERIALS AND METHODS: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning. RESULTS: Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). CONCLUSIONS: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.
Carcinoma, Renal Cell ; Constriction* ; Creatinine ; Filtration ; Humans ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy* ; Renal Artery ; Veins ; Warm Ischemia

The standard treatment for a small mass has shifted from radical nephrectomy to partial nephrectomy. The benefits of partial nephrectomy, including preserving renal function, prolonging overall survival, preventing postoperative chronic kidney disease, and reducing cardiovascular events, have been discussed in many studies. With the accumulation of surgeons' experience and simplification of the operative procedures, the warm ischemic time has become shorter despite the indication of tumor size becoming larger. With the help of intraoperative ultrasound, partial nephrectomy can be performed for an endophytic renal mass. Recently, laparoscopic partial nephrectomy has become well indicated for most renal tumors in many centers with advanced laparoscopic expertise. Open partial nephrectomy remains indicated for complex tumors. With technical innovation, robotic partial nephrectomy shows at least comparable perioperative outcomes with a benefit for challenging cases. Laparoendoscopic single-site partial nephrectomy has recently been tried in limited indications and seems to be feasible.
Kidney Neoplasms ; Nephrectomy ; Renal Insufficiency, Chronic ; Surgical Procedures, Operative ; Warm Ischemia