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Page 8 of 13 Parra et al. Mini-invasive Surg 2024;8:16 https://dx.doi.org/10.20517/2574-1225.2024.01

Figure 7. Correlation between Charlson index and GFR. GFR: Glomerular filtration rate.

Figure 8. Simple box plot of R.E.N.A.L. score and ischemia time.

The European Association of Urology (EAU) Guidelines update in 2023 defend with a strong power to
[5]
offer PN to patients with T1 tumors. There are three important caveats in relation to PN: time of warm
ischemia, surgical margins and surgical technique. We have focused our work on the evolution of the
impact of arterial clamping over the last decade.

Throughout PN, the principal artery is usually clamped to reduce blood loss and create a quite controlled
[12]
field for tumor removal and subsequent reconstruction of the renal parenchyma . It has been illustrated
that ischemia secondary to clamped PN will probably produce damage to nephrons through numerous
conjectured mechanisms, such as vasoconstriction, tubular obstruction with backflow of urine, and
[15]
reperfusion injury [13-15] . With the beginning of studies that measure preserved nephronal quantity ,
irrespective of whether it is a single kidney or bilateral kidney, they conclude that the percent GFR
conserved was most strongly related with the percentage of parenchymal quantity spared. Besides, several
studies have measured atrophy of the conserved renal tissue for assessing the degree of possible ischemic
shock on the operated kidney through clamped PN and have described no significant atrophy after clamped
PN [16,17] .

In our experience and following the latest recommendations published in the literature, partial
nephrectomies have been performed by expert surgeons of the department, always trying to preserve as