Multidisciplinary approach to the treatment of kidney cancer: temporary balloon occlusion during laparoscopic partial nephrectomy

Introduction. Organ-preserving treatment for localized renal cell carcinoma requires the use of renal warm ischemia (RWI). Establishing access to the renal vessels is a surgical procedure associated with a high risk of bleeding. However, RWI, once blood flow is restored, can cause ischemia-reperfusion injury to the renal parenchyma. An alternative to standard RWI is temporary balloon occlusion (TBO) of the renal artery using a dual-lumen Fogarty catheter. TBO offers comparable advantages in ensuring intraoperative hemostasis and a comparable safety profile, particularly in repeat interventions for neoplasms in the ipsilateral kidney.

Objective. To evaluate the outcomes of laparoscopic partial nephrectomy (LPN) for neoplasms using RWI of the renal artery compared to LRN under TBO.

Materials and Methods. Between September 2022 and November 2024, seven patients with localized RCC (tumor size £ 4.8 cm) underwent treatment. Analysis focused on surgery duration, procedural steps, intraoperative blood loss, oncological radicality as per histopathological examination, intraand postoperative complications, and length of hospital stay.

Results. The following advantages were found for LPN under TBO (n = 7) compared to LRN under RWI (n = 78, based on a previous study): 1) comparable surgical time; 2) identical hospital stay; 3) threefold reduced intraoperative blood loss; 4) absence of infectious and inflammatory complications. The study identified additional advantages of LRN under TBO: no risk of damage to the structural elements of the renal vessels during dissection, especially in patients with repeated interventions on the same side; radical intervention; and the ability to reduce the degree of ischemia-reperfusion injury to the remaining renal parenchyma due to the possibility of selective occlusion of renal artery branches.

Conclusion. TBO of the renal artery branches feeding the tumour, along with minimally invasive organ-preserving treatment for RCC, allows for improved functional outcomes. This is achieved by mitigating the risk of damage to the renal vessels, reducing intraoperative blood loss, and eliminating the need for RWI, which is associated with alteration of the preserved renal tissue.

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