Nephron sparing surgery for localized renal tumors has gained increasing acceptance as a standard of care in appropriately selected patients.
Much has been made of the importance of limiting ischemia time to the kidney, during renal artery clamping and tumor resection, to avoid irreversible ischemic damage to the retained renal parenchyma. Some clinicians have proposed that the renal artery rarely needs to be occluded during tumor resection, but rather external compression ("the grip of death") can be used as an alternative to control bleeding during tumor resection and thus minimize ischemic time to the rest of the kidney. Here, Duvdevani and colleagues examine their experience with nephron sparing surgery over a 15 year period in a retrospective fashion, to determine the potential morbidity and benefits of renal artery occlusion during nephron sparing surgery for localized renal tumors.