Study
Proponents |
RCT |
Design |
Population |
Conclusion |
Limitations |
Is Ischemia a Primary
Predictor of Renal Function? |
Lane et al. [4] |
No |
Prospective Comparative
Study |
660 |
With short intervals
ischemia is not a predictor of renal function |
1.Retrospective
2.Subjective
estimate of preserved parenchyma
3.Missing data |
No;
WIT is not an
independent factor
predicting renal
function |
Spana et al. [5] |
No |
Retrospective |
450 |
Most complications
are Clavien
I and II |
No objective renal mass
scoring used resulting
in difficulty correlating
WIT and complications |
No;
At an average of
20 (Range 0‐83)
minutes
WIT only had 1ARF (2%) |
Bhayani et al. [6] |
No |
Retrospective |
118 |
Based on post‐op Crea, WIT of up to
55 mins does not influence long term
Renal function |
1. All patients had Normal contralateral kidney, normal
Creatinine may be due to their compensation |
No;
WIT does not
significantly alter
long term Renal function |
Papalia et al. [7] |
No |
Prospective |
60 |
Controlled hypotension
allowed LPN and
RPN to be done
without clamping |
1. It assumed warm ischemia
Is harmful
2. Median Controlled Hypotension time is 14 minutes |
Yes;
WIT is assumed
as a predictor
af ultimate
Renal function |
Gill et al. [8] |
No |
Prospective |
58 |
Global surgical
Ischemia can be
avoided by anatomical vascular
microdissection |
1.Mean follow‐ up 3 mos.
Short‐ term functional
outcomes only.
2.Small population |
Yes;
Extrapolated based
on collective experience with
>800 patients |
Porpiglia et al. [9] |
No |
Prospective |
54 |
WIT contributes
To irreversible damage observed
at 3 mos but does
not worsen |
After 4 years of follow--‐up
Data it concluded That only limited injury can be caused
By 27.8 mins of WIT. No
Correlation with hypertension development
And post‐ ischemic renal
failure |
Yes;
Multivariable analysis shows
WIT is an
independent
predictor of SRF
and ERPF baseline
weighted differential changes
at 3 months
post‐op |
Bollens et al. [10] |
No |
Retrospective |
39 |
Extracorporeal
clamping
significantly
decreases WIT |
No explanation for 2 patients having significant
Renal impairment |
Yes |
Funahashi etal.[11] |
No |
Prospective |
32 |
WIT>25 mins
causes irreversible
Diffuse damage |
1. Non‐use of ACS to classify tumor complexity
2. It did not account for
Amount of tissue resected
3. Suture width |
Yes;
WIT>25 mins
Causes irreversible
Diffuse parenchymal damage |
Holzer et al. [12] |
No |
Prospective |
21 |
HSI is a real time non-invasive renal
Oxygenation monitoring.
Renal oxygenation
Reaches a nadir
10 mins after
clamping |
Unidentified confounding
Variable causing renal
Reoxygenation despite complete occlusion |
Yes it assumed
WIT is a factor
In determining
Post treatment
Renal function,
showcases
a novel way
of monitoring
ischemia |
Gill et al. [13] |
No |
Prospective |
15 |
Promising initial
Results (hence
Study was continued) |
1. Not for all patients.
2. Not applicable to all
surgeons |
Yes it assumed
WIT is afactor
In determining
post‐op renal function |
Raman et al. [14] |
No |
Animal Experimental |
18 Pigs |
PRAC and
SRPC demonstrate
Better oxygenation
Profiles than
TRAC.
SRPC kidneys
Demonstrated a
Decline in oxygenation
profiles |
No actual Tumor to take into
account. |
Yes;
Assumes WIT
Is a factor
In determining
Post ‐op renal
Function showcases
A novel way
Of monitoring ischemia |
Baldwin et al. [15] |
Yes |
Animal Experimental |
16 Pigs |
Renal ischemic
Times up to 90 Minutes were well
Tolerated by Solitary porcine
kidneys. |
Ischemic
preconditioning |
No;
WIT is not
An independent
Factor predicting
renalfunction |
Best et al. [16] |
No |
Animal Experimental |
14 Pigs
Incomplete
RA occlusion |
Incomplete RA occlusion during
Porcine PN
Resulted in favorable
Renal oxygenation
Profiles with as little
as10% BF, renoprotective at 25% of baseline |
1Small population
2. Imperfect human translation
Due to unique porcine
characteristics |
Yes;
Assumes WIT is
A factor in
determining
post‐op renal
function, showcases
a novel way
of monitoring ischemia |
Parekh D. [17] |
No |
Editorial |
NA |
In majority of pts
Tumor resection Can be accomplished
Safely without
Impacting on renal function |
No
power |
No;
WIT does not
significantly
alter long term
renal function |
Gill and Campbell [18] |
No |
Editorial |
NA |
Presents opposing
views |
No power |
Equivocal |
Abbreviation: WIT – Warm Ischemia Time, LPN – Laparascopic Partial Nephrectomy, RPN: Robotic Partial Nephroctomy, SRF: Split Renal Function, ERPF: Effective Renal Plasma Flow, CKD: Chronic Kidney Diseas, HIS- Hyperspectral Imaging, TRAC- Total Renal Artery Occlusion, PRAC- Partial Renal Artery Occlusion, SRPC: Selective Renal Parenchymal Clamping, ACS-Anatomic Classification System, RCT- Randomized Controlled Trial