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Parra et al. Mini-invasive Surg 2024;8:16 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2024.01

Original Article Open Access

Ischemia time in partial nephrectomy: to rush really

matters?

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Irene de la Parra 1 , Juan Gómez Rivas , Álvaro Serrano , Roser Vives 2 , Beatriz Gutiérrez Hidalgo , Juan
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Francisco Hermida , Laura Ibañez , Lorena Fernández Montarroso , Jesús Moreno-Sierra 1
1
Department of Urology, Clínico San Carlos University Hospital, Institute for Health Research. Universidad Complutense de
Madrid, Madrid 28040, Spain. Madrid 28040, Spain.
2
Derpartment of Urology, Infanta Leonor University Hospital, Madrid 28031, Spain.
Correspondence to: Dr. Irene de la Parra, Department of Urology, Clínico San Carlos University Hospital, Professor Martin Lagos
s/n, Madrid 28040, Spain. E-mail: irn_parra@hotmil.com
How to cite this article: de la Parra I, Gómez Rivas J, Serrano Á, Vives R, Gutiérrez Hidalgo B, Hermida JF, Ibañez L, Fernández
Montarroso L, Moreno-Sierra J. Ischemia time in partial nephrectomy: to rush really matters? Mini-invasive Surg 2024;8:16.
https://dx.doi.org/10.20517/2574-1225.2024.01
Received: 2 Jan 2024 First Decision: 13 Jun 2024 Revised: 6 Jul 2024 Accepted: 30 Jul 2024 Published: 26 Aug 2024

Academic Editors: Giulio Belli, Michele Marchioni, Luigi Schips Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
Aim: The growth in the incidence of small renal masses has led the implementation of laparoscopic partial
nephrectomy to become the technique of choice. However, arterial clamping and secondary renal ischemia still
mean a controversial issue due to the risk of renal failure. Our objective is to evaluate the existing literature and its
relationship to our experience.

Methods: We performed a retrospective study of our series over six years. We analyzed different clinical,
perioperative and postoperative functional outcome variables and compared the relationship between tumor
complexity and the need for ischemia as well as the relation between ischemia time and renal function over a
follow-up time of 6 months. For the discussion, we led a review of the literature on the subject and the paradigm
shift that has taken place over the years.
Results: A total of 148 patients, most of them male (68.2%) with an average age of 62.4 [standard deviation (SD)
1.7] years, had a Charlson index of 3 [interquartile range (IQR) 1-4]. The average R.E.N.A.L. score was 6 (IQR 5-8).
Intraoperative complications were observed in 8.1% of the cases, most of which involved bleeding from a major
artery or vein (7.4%). Postoperative complications occurred in 23.6% of the patients, the majority being classified
as Clavien 2. Arterial clamping was carried out in 52.7% of the interventions, with a median ischemia time of 8 min
(IQR 0-18). The average hospital stay was three days (IQR 2-5). Previous median glomerular filtration rate (GFR)

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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