A System For Preoperative Assessment Of Laparoscopic Partial Nephrectomy With Segmental Renal Artery Clamping

Objective: Laparoscopic partial nephrectomy with segmental renal artery clamping is associated with less warm ischemic injury and better postoperative affected renal function compared with main renal artery clamping.However,its indication remains unclear.Methods: We established a standardized nephrometry scoring system(The C.L.A.M.P.Nephrometry Score)to evaluate its flexibility in preoperative assessment.This scoring system based on 5 components.The ranking(C)oefficient of each score,(L)ocation of the clamping position of the target artery and areas of the target artery entering the renal sinus:(A)nterior boundary,(M)ulti-boundary and(P)osterior boundary.We applied this system to analyze data from 106 consecutive patients who underwent SRAC during LPN and divided these patients into 3 groups based on their C.L.A.M.P.scores.Results: The rate of conversion to main renal artery clamping and clamping success rate and the affected side GFR reduction showed significant differences among the groups(P<0.001).However,parameters such as blood loss,Warm ischemia time and postoperative hospitalization were not significantly different.Conclusion: The C.L.A.M.P.nephrometry score shows strong ability in distinguishing different complexities of artery characteristics and plays a promising role in identifying patients who are suitable for the SRAC technique.