Non-ischemic partial nephrectomy with the Hydrojet resection technique“
Non-ischemic partial nephrectomy with the hydrojet resection technique
G. Gakis, T. Schubert, F. Hassan, I. Sokolakis, M. Ölschläger, G. Hatzichristodoulou, H. Kübler
Universitätsklinikum Würzburg, Klinik und Poliklinik für Urologie und Kinderurologie, Würzburg, Deutschland
Introduction: Temporary clamping of the renal artery during partial nephrectomy for renal tumours may result in loss of renal function. In hepatic surgery, waterjet-based resection techniques have been utilized for non-ischemic resection of hepatic lesions for many years. The objective of this study was to investigate the perioperative outcomes of this surgical technique for renal cancer patients.
Material and methods: Between April and August 2018, a total of five patients with renal tumors were treated at our center using non-ischemic hydrojet resection. Only patients with a solitary tumor lesion and with a RENAL Score of < =9 were considered suitable candidates for this method. Patient comorbidities were assessed by the Charlson Comorbidity Index (CCI) with high CCI defined as a score of >=10.
Results: Median age was 70 years (56-84) and the CCI ranged from 4 to 11 (median: 10). RENAL score was intermediate in four (7p, 8p, 8p, 9a) and low (6p) in one patient (median score: 8). Median non-ischemic resection time was 25 minutes (range: 24-35) and median intraoperative blood loss was 300 ml (100-300). Median preoperative GFR-MDRD was 81 ml/min (23-108) and 87 ml/min (29-105) postoperatively. Two patients developed a grade II complication postoperatively which was managed conservatively. Surgical margins were negative in all five patients and malignant disease was confirmed in three. At 6-month follow-up none of the patients had developed any local or distant recurrence.
Conclusions: The results of this analysis suggest that the hydrojet resection is a safe and reproducible technique for nonischemic resection of renal lesions in patients with low to intermediate risk tumors. Further studies are necessary to confirm these initial findings.