Application value of CTA-guided renal artery branch clamping in laparoscopic nephron-sparing surgery(Report of 11 cases)

Objective:To evaluate the application value of individual CTA-guided renal artery branch clamping in laparoscopic nephron-sparing surgery.Method:A retrospective analysis of retroperitoneal laparoscopic nephronsparing surgery with selectively renal artery branch clamping in our hospital from October 2012to December 2013was made.A total of 11cases included one case of renal tumor in solitary kidney.Average diameter of tumor was3.0(range,1.8-4.2)cm.According to preoperative CTA,we made individual renal artery branch clamping program,including two cases of ramus posterior arteriae renalis,five cases of ramus anterior arteriae renalis,two cases of segmental renal artery and two cases of accessory renal artery.The blood loss,the extent of clarity in the surgical field,clamping time,operation time,postoperative complications and renal function were evaluated.Result:All surgeries went smoothly.The renal artery branch clamping programs were carried out according to the preoperative schedule,while two cases changed to the main renal arteries clamping because of heavy bleeding.The average operation time was 85(range,56-114)min and the average blood loss was 120(range,20-220)ml.The average blocking time was 21(range,12-35)min and the average postoperative drainage was 90(range,30-150)ml.No urinary leakage was found.The creatinine slightly increased postoperatively just in the case of solitary kidney,and then returned to preoperative level seven days later.Conclusion:Based on preoperative CTA,individual renal artery branch clamping program can be carried out in the laparoscopic nephron-sparing surgery.This technique can reduce the extent of renal ischemia and protect the renal function as much as possible.Moreover,it's practical and safe.