To determine whether performing robot-assisted partial nephrectomy without warm ischemia "off-clamp" results in favorable postoperative renal functional outcomes compared with the on-clamp method.
We conducted a prospective trial of 80 patients who underwent robot-assisted partial nephrectomy. They were randomized in a 1:1 ratio to undergo the procedure with renal artery clamping or without clamping. The groups were compared across demographics, operative information, perioperative outcomes, and postoperative renal function. We assessed renal function by estimated glomerular filtration rate and renal scintigraphy both preoperatively and at three months postoperatively.
Patients in the on-clamp and off-clamp groups were similar in age, gender, body mass index, co-morbidities, clinical tumor size, nephrometry score, and laterality. Off-clamp procedures were lengthier at an average 178.0 minutes versus 156.0 minutes for on-clamp (p=0.011). Estimated blood loss, rates of pelvicalyceal repair, postoperative complications, and positive margins were not different. At a median three-month follow-up, no significant differences were seen in change in postoperative estimated glomerular filtration rate or percent split renal function between both groups.
In this prospective study, off-clamp robot-assisted partial nephrectomy resulted in similar perioperative outcomes compared with the on-clamp technique. No benefit was demonstrated in the preservation of renal function. Urologists may safely employ either an on-clamp or off-clamp strategy depending on surgeon preference and patient-specific factors including baseline renal insufficiency, multiple masses, or solitary kidney.
Urology. 2019 Jan 16 [Epub ahead of print]
Barrett G Anderson, Aaron M Potretzke, Kefu Du, Joel M Vetter, Karla Bergeron, Alethea G Paradis, R Sherburne Figenshau
Department of Urology, Detroit Medical Center, Detroit, Michigan. Electronic address: ., Department of Urology, Mayo Clinic, Rochester, Minnesota. Electronic address: ., Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: ., Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: ., Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: ., Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: ., Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri. Electronic address: .