Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York, 2013
Efforts to further reduce warm ischemia time to normal renal parenchyma have led to zero-ischemia techniques with superselective blood flow interruption of tertiary or higher-order arteries via clamping or embolization. Our institution developed a technique for angiographic delivery of a reverse thermosensitive polymer (Lumagel, Pluromed Inc., Woburn, MA, USA) to reliably interrupt blood flow to tumor-specific arteries. The polymer contains a contrast agent and works by increasing viscosity when warmed to body temperature upon injection into the targeted artery and returns to its less viscous state upon recooling. A recent randomized study comparing hilar clamping to selective arterial branch occlusion using Lumagel in porcine models demonstrated success in performing bloodless partial nephrectomy. At 6 weeks necropsy was performed which showed no evidence of gross or microscopic damage to the remaining ipsilateral kidney or endothelium at the prior plug location.
Lastly, significant data heterogeneity exists among reports for minimally invasive nephronsparing treatment. If evidence-based decisions are to be made on the available literature, more standardized reporting is necessary. More authors are utilizing the Clavien classification for reporting postoperative complications and the nephrometry scoring for complexity of lesions [27, 91]. Going forward, using these classification structures will help with future meta-analysis. Standard definitions of intraoperative complications have not yet been established.