Laparoscopic Partial Nephrectomy with Superselective Arterial Clamping: Surgical Technique

Clinical History: Asymptomatic patient. Physical Examination: Unremarkable. Diagnosis: A computed tomography scan revealed a suspicious slightly exophytic 16 mm nodular lesion on the anterior aspect of the left renal upper pole. A magnetic resonance imaging confirmed the suspicion of a renal cell carcinoma (RCC), most likely clear cell. Intervention: We placed four trocars transperitoneally, in a slightly adapted particular position, allowing better surgical site access and surgeons' ergonomics. We carefully isolated the main renal vein and artery (with early bifurcation), the renal artery (RA) anterior branch, and two of its segmental branches, one of which was vascularizing kidney upper pole and tumor. Laparoscopic partial nephrectomy (LPN) was performed with superselective clamping of this segmental RA. Follow-Up/Outcomes: Clamping time was 11 minutes and total operative time 90 minutes. Creatinine remained exactly the same. Pathologic report confirmed clear cell RCC, G1pT1aNxR0. In 12 months of follow-up, there were no complications. Despite the early bifurcated renal hilum, the eccentric course of the RA encircling the vein, and the upper pole tumor location, we have demonstrated that LPN with superselective arterial clamping is feasible, did not increase hemorrhage neither hampered the LPN, which was rapidly and standardly performed, without extraordinary surgical material, complications, or oncologic outcome compromise, and with total renal function preservation. However, we recognize that it requires demanding laparoscopic expertise, and technological assistance may be helpful, for example, for better delineation of kidney and tumor vascularization and surgical planning. Still, adequate positioning and anatomical planes dissection are key elements for surgical success. No competing financial interests exist. Runtime of video: 5 mins 0 secs Authors' Contributions: All authors contributed to the design of the study, are accountable for all aspects of the study, and have approved the final article for publication. Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Prior abstract presentations: UROtech22, May 26–28, 2022, Istanbul, Turkey; 6th AIM ACELAS—Algerian Community of Endourology and Laparoscopic Surgery—INTERNATIONAL MEETING, September 29–October 1, 2022, Algiers, Algeria.