Demirtas’ early renal vascular control technique (DERVACT): A novel technique for open partial nephrectomy

Abstract

“Demirtas’ Early Renal Vascular Control Technique (DERVACT)” is a novel technique for renal pedicle control that aims to achieve rapid and direct access to the renal artery through the retroperitoneal space and then the superior-dorso-lateral aspect of the kidney. In this study, we aimed to introduce DERVACT and to present the initial outcomes of this technique. This retrospective-observational study compared two groups of patients that were operatively treated by the same surgical team using two different nephron sparing surgery (NSS) procedures. Group I (n=95) underwent standard open NSS and Group II (n=92) underwent open NSS with the DERVACT between Jan 2015 and July 2020. Mean age was 56.42 ± 13.27 years. No significant difference was found between the two groups with regard to age, gender, Body mass index, mass laterality and size, and the Padua and c-index scores (p=0.087, p=0.354, p=0.642, p=0.957, p=0.200, p=0.101, p=0.361, respectively). Similarly, no significant difference was found between the DERVACT group and the other group with regard to ischemia duration (20.0 [15.0-30.0] min vs. 18.5 [11.0-27.0] min, respectively, p=0.060) and intraoperative vascular complication rate (6.3% vs. 1.1%, respectively. p=0.059). However, non-ischemic operative time was significantly shorter in the DERVACT group than in the standard partial nephrectomy group (64.0 [50.0-75.0] vs. 84.0 [61.0-105.0], p<0.001). As a conclusion, DERVACT is a simple, time-saving, and safe procedure for NSS that can be used in clinics with no opportunities for robotic-laparoscopic partial nephrectomy or in open partial nephrectomy.

Keywords

• kidney surgery
• retroperitoneal approach
• vascular anatomy
• partial nephrectomy

References

1. 1. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L, Gervais DA, Hu SL, Lane BR, Leibovich BC, Pierorazio PM. Renal Mass and Localized Renal Cancer: AUA Guideline. J Urol. 2017;198(3):520-529. doi: 10.1016/j.juro.2017.04.100.
2. 2. Kletscher BA, Lauvetz RW, Segura JW. Nephron-sparing laparoscopic surgery: techniques to control the renal pedicle and manage parenchymal bleeding. J Endourol. 1995;9(1):23-30. doi: 10.1089/end.1995.9.23.
3. 3. Kenney PA, Wotkowicz C, Libertino JA. Contemporary Open Surgery of the Kidney. Campbell-Walsh Urology. 2012; 2: 1567-8.
4. 4. Leslie S, Goh AC, Gill IS. Partial nephrectomy--contemporary indications, techniques and outcomes. Nat Rev Urol. 2013;10(5):275-83. doi: 10.1038/nrurol.2013.69.
5. 5. Russo P. Open partial nephrectomy. Personal technique and current outcomes. Archivos espanoles de urologia. 2011; 64(7), 571–593.
6. 6. Azhar RA, Metcalfe C, Gill IS. Anatomic partial nephrectomy: technique evolution. Curr Opin Urol. 2015 Mar;25(2):95-9. doi: 10.1097/MOU.0000000000000140.
7. 7. Minervini A, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, et al. Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study. J Urol. 2020;203(3):496-504. doi: 10.1097/JU.0000000000000591.
8. 8. Zhang C, Wang F, Shi X, Guo F, Wang H, Yang Y, et al. Direct Lateral Access to Renal Artery During Transperitoneal Laparoscopic Partial Nephrectomy: Surgical Technique and Comparative Outcomes. Urology. 2018; 120:120-124. doi: 10.1016/j.urology.2018.07.014.

9. 9. Standring S. The Anatomical Basis of Clinical Practice. 39th edition. New York, NY, USA: Elsevier, Churchill Livingstone, Gray’s anatomy. 2005; pp. 1271–4.
10. 10. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786-93. doi: 10.1016/j.eururo.2009.07.040.
11. 11. Porpiglia F, Terrone C, Cracco C, Renard J, Musso F, Grande S, et al. Direct access to the renal artery at the level of treitz ligament during left radical laparoscopic transperitoneal nephrectomy. Eur Urol. 2005;48(2):291-5. doi: 10.1016/j.eururo.2005.03.024.
12. 12. Porpiglia F, Renard J, Billia M, Morra I, Scoffone C, Cracco C, et al. Left laparoscopic radical nephrectomy with direct access to the renal artery: technical advantages. Eur Urol. 2006;49(6):1004-10. doi: 10.1016/j.eururo.2006.02.038.
13. 13. Porpiglia F, Terrone C, Cracco C, Cossu M, Grande S, Musso F, et al. Early ligature of renal artery during radical laparoscopic transperitoneal nephrectomy: description of standard technique and direct access. J Endourol. 2005;19(6):623-6; discussion 626-7. doi: 10.1089/end.2005.19.623.
14. 14. Tunc L, Canda AE, Polat F, Onaran M, Atkin S, Biri H, et al. Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique. Surg Laparosc Endosc Percutan Tech. 2011;21(6):453-7. doi: 10.1097/SLE.0b013e31823badc1.
15. 15. Yang F, Zhou Q, Li X, Xing N. The methods and techniques of identifying renal pedicle vessels during retroperitoneal laparoscopic radical and partial nephrectomy. World J Surg Oncol. 2019;17(1):38. doi: 10.1186/s12957-019-1580-1.
16. 16. Nouralizadeh A, Ziaee SA, Basiri A, Simforoosh N, Abdi H, Mahmoudnejad N, Kashi AH. Transperitoneal laparoscopic partial nephrectomy using a new technique. Urol J. 2009;6(3):176-81.
17. 17. Zapala P, Dybowski B, Miazek N, Radziszewski P. Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate. Int Braz J Urol. 2017;43(2):209-215. doi: 10.1590/S1677-5538.IBJU.2016.0040.
18. 18. Pereira J, Renzulli J 2nd, Pareek G, Moreira D, Guo R, Zhang Z, et al. Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. J Endourol. 2018;32(2):116-123. doi: 10.1089/end.2017.0609.
19. 19. Wu Z, Li M, Liu B, Cai C, Ye H, Lv C, et al. Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS One. 2014;9(4):e94878. doi: 10.1371/journal.pone.0094878.
20. 20. Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol. 2014;191(4):907-12. doi: 10.1016/j.juro.2013.10.099.