Advancements in zero ischemia and sutureless techniques for minimally invasive partial nephrectomy in the treatment of localized kidney neoplasms
10.3760/cma.j.cn115396-20250926-00238
- VernacularTitle:"零缺血"和"免缝合"技术在微创肾部分切除术中治疗局限性肾肿瘤的研究进展
- Author:
Xiaosong XU
1
;
Bo HAN
Author Information
1. 陆军军医大学第一附属医院肾科，重庆 400038
- Keywords:
Kidney neoplasms;
Surgical procedures, minimally invasive;
Postoperative complications;
Zero ischemia;
Sutureless;
Partial nephrectomy
- From:
International Journal of Surgery
2025;52(10):649-657
- CountryChina
- Language:Chinese
-
Abstract:
With advancements in imaging technology, the detection rate of localized renal neoplasms has significantly increased. Minimally invasive partial nephrectomy now represents the mainstream approach for nephron-sparing surgery. However, the potential impairment of residual renal function due to warm ischemia-reperfusion injury and renal wound suturing during traditional surgical procedures constitutes key challenges in current therapeutic management. Maximizing renal parenchymal preservation and reducing ischemia time are core objectives for optimizing efficacy. Zero ischemia techniques aim to avoid or minimize warm ischemia and thereby prevent ischemia-reperfusion injury. This is achieved through strategies including preoperative superselective transarterial embolization, segmental renal artery clamping, early unclamping, or completely off-clamp renal artery management. An completely off-clamp partial nephrectomy is considered the ideal approach for maximal renal function preservation, although it presents challenges in bleeding management. Compared to traditional suturing, sutureless techniques, designed to overcome renal parenchymal damage and reduce ischemia time, leverage tools like electrocoagulators, argon beam coagulator, and various lasers for efficient hemostasis at the renal wound. These techniques significantly reduce damage to renal parenchyma, potentially improving postoperative renal function and lowering the incidence of complications such as urinary leakage. Zero ischemia and sutureless techniques are pivotal developmental directions in renal functional preservation within the field of minimally invasive partial nephrectomy. Therefore, this article reviewed the literature pertaining to these innovative techniques, summarizing the relevant clinical experiences and potential limitations, in order to furnish actionable guidance and essential theoretical support for their broader clinical implementation.
