Objective: The study aimed to evaluate the ischemic and non-ischemic areas after selective arterial occlusion by using stereological analysis of glomeruli, and to compare them with main arterial clamping and sham-operated animals. Materials and Methods: Twenty-four male pigs were used in the study. The animals were divided into 3 groups with 8 animals in each as follows: group sham, submitted to laparoscopic dissection of the renal pedicle but not submitted to ischemia; group arterial (A), submitted to left renal artery clamping; and group selective (S), submitted to left renal artery caudal branch occlusion. Groups A and S underwent 30 min of warm ischemia. Left and right kidneys were collected after 21 days and renal fragments were processed for stereological evaluation. Glomerular volume density (Vv[glom]), mean glomerular volume (MGV), and glomerular density were measured. Serum creatinine and urea were assessed preoperatively, 10 days after surgery, and before euthanasia. Results: There was no significant difference among groups with regard to renal function. Renal weight and volume were similar among groups. Also, no difference was observed between the groups with regard to Vv[glom], MGV, and glomerular density, both when compared to its right control or when left kidneys were compared. Conclusions: Selective arterial clamping technique was neither superior nor inferior to main artery clamping.

Keywords:
Warm ischemia, Nephrons, Animal models, Swine, Partial nephrectomy
1.
Touijer K, Jacqmin D, Kavoussi LR, et al: The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 2010;57:214-222.
2.
Kalogirou C, Fender H, Muck P, et al: Long-term outcome of nephron-sparing surgery compared to radical nephrectomy for renal cell carcinoma ≥4 cm - a matched-pair single institution analysis. Urol Int 2016, Epub ahead of print.
3.
Thompson RH, Lane BR, Lohse CM, et al: Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 2012;79:356-360.
4.
Volpe A, Blute ML, Ficarra V, et al: Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol 2015;68:61-74.
5.
Kriegmair MC, Pfalzgraf D, Häcker A, Michel MS: ZIRK-technique: zero ischemia resection in the kidney for high-risk renal masses: perioperative outcome. Urol Int 2015;95:216-222.
6.
Satkunasivam R, Tsai S, Syan S, et al: Robotic unclamped “minimal-margin” partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. Eur Urol 2015;68:705-712.
7.
Simone G, Gill IS, Mottrie A, et al: Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: a systematic review of the literature. Eur Urol 2015;68:632-640.
8.
Benway BM, Baca G, Bhayani SB, et al: Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: impact upon renal function in the setting of a solitary kidney in a porcine model. J Endourol 2009;23:1127-1133.
9.
Desai MM, de Castro Abreu AL, Leslie S, et al: Robotic partial nephrectomy with superselective versus main artery clamping: a retrospective comparison. Eur Urol 2014;66:713-719.
10.
Shao P, Qin C, Yin C, et al: Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur Urol 2011;59:849-855.
11.
Komninos C, Shin TY, Tuliao P, et al: Renal function is the same 6 months after robot-assisted partial nephrectomy regardless of clamp technique: analysis of outcomes for off-clamp, selective arterial clamp and main artery clamp techniques, with a minimum follow-up of 1 year. BJU Int 2015;115:921-928.
12.
Martin GL, Warner JN, Nateras RN, Andrews PE, Humphreys MR, Castle EP: Comparison of total, selective, and nonarterial clamping techniques during laparoscopic and robot-assisted partial nephrectomy. J Endourol 2012;26:152-156.
13.
Bagetti-Filho HJ, Sampaio FJ, Marques RG, Pereira-Sampaio MA: Different from renal artery only clamping, artery and vein clamping causes a significant reduction in number of rat glomeruli during warm ischemia. J Endourol 2012;26:1335-1339.
14.
de Souza DB, de Oliveira LL, da Cruz MC, et al: Laparoscopic partial nephrectomy under warm ischemia reduces the glomerular density in a pig model. J Endourol 2012;26:706-710.
15.
Pereira-Sampaio MA, Favorito LA, Sampaio FJ: Pig kidney: anatomical relationships between the intrarenal arteries and the kidney collecting system. Applied study for urological research and surgical training. J Urol 2004;172(5 pt 1):2077-2081.
16.
Pereira-Sampaio M, Favorito LA, Henry R, Sampaio FJ: Proportional analysis of pig kidney arterial segments: differences from the human kidney. J Endourol 2007;21:784-788.
17.
Benchimol de Souza D, Silva D, Marinho Costa Silva C, Barcellos Sampaio FJ, Silva Costa W, Martins Cortez C: Effects of immobilization stress on kidneys of Wistar male rats: a morphometrical and stereological analysis. Kidney Blood Press Res 2011;34:424-429.
18.
Souza DB, Costa WS, Cardoso LE, Benchimol M, Pereira-Sampaio MA, Sampaio FJ: Does prolonged pneumoperitoneum affect the kidney? Oxidative stress, stereological and electron microscopy study in a rat model. Int Braz J Urol 2013;39:30-36.
19.
Guillonneau B, Bermudez H, Gholami S, et al: Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 2003;169:483-486.
20.
Bechara GR, Damasceno-Ferreira JA, Abreu LA, et al: Glomerular loss after arteriovenous and arterial clamping for renal warm ischemia in a swine model. Acta Cir Bras 2016;31:753-758.
21.
Thompson RH, Lane BR, Lohse CM, et al: Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol 2010;58:331-336.
22.
Becker F, Van Poppel H, Hakenberg OW, et al: Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 2009;56:625-634.
23.
de Souza DB, Abilio EJ, Costa WS, Sampaio MA, Sampaio FJ: Kidney healing after laparoscopic partial nephrectomy without collecting system closure in pigs. Urology 2011;77:508.e5-e9.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.