Early versus standard unclamping of the renal artery in laparoscopic partial nephrectomy: The Lebanese experience

Abstract

Objectives:

To assess the feasibility and safety of early unclamping of the renal artery during laparoscopic partial nephrectomy (LPN) for localized renal tumors, by comparing the perioperative outcomes of early versus standard unclamping techniques in a tertiary care center in Lebanon.

Material and methods:

This retrospective study included patients who underwent pure or hand-assisted LPN between 2017 and 2020. Patients were categorized into early unclamping (EUC)—where the renal artery was unclamped after placement of the initial sutures on the tumor bed—and standard unclamping (SUC)—where clamping was maintained until renorrhaphy was complete. Perioperative parameters, tumor characteristics, kidney function, complication rates, and pathological outcomes were compared. Multivariable analysis, sensitivity analysis, and stratification were conducted to explore predictors of warm ischemia time (WIT), complications, and other outcomes.

Results:

Forty-nine patients were included (37 SUC, 12 EUC). EUC was associated with a significantly shorter warm ischemia time compared with SUC (15 min vs 25 min, p < 0.001), with a trend toward shorter operative time. Complication rates, transfusion requirements, and positive surgical margins did not differ significantly between groups. Multivariable analysis suggested that EUC was independently associated with shorter warm ischemia time, while tumor size appeared to be the main predictor of complications. Sensitivity analysis also indicated an association between tumor size and complications, and stratified analysis suggested that complications tended to occur more frequently in complex tumors.

Conclusions:

Early unclamping in LPN is a feasible and safe technique that reduces WIT without compromising visibility during tumor resection or renorrhaphy. This strategy theoretically supports favorable functional and oncologic outcomes, though definitive evidence is limited by the lack of long-term follow-up. Larger prospective studies are needed to confirm these potential benefits.