INTRODUCTION Hilar clamping is often performed to facilitate robotic partial nephrectomy (RPN). Minimal clamping techniques may reduce renal ischemia, including early unclamping, selective clamping, and off-clamp RPN. We assess the utilization of clamping techniques in a large international consortium of surgeons performing RPN for complex tumors. METHODS We retrospectively evaluated 721 patients with complex tumors who underwent RPN at 11 centers worldwide between 2008 and 2014. Complex tumors were defined as renal masses with a nephrometry score > 6. Total clamping was defined as complete clamping of the main renal artery. Minimal clamping techniques included early unclamping, selective clamping, and off-clamp RPN. Clamping techniques were additionally assessed in patients with eGFR<60 and in patients with a solitary kidney. Two-tailed t-tests (p < 0.05) were used to statistically analyze differences in mean warm ischemia time. RESULTS Most patients underwent complete clamping (75.1%). Minimal clamping (24.9%) included early unclamping (10.8 %), selective clamping (8.7%), and off-clamp (5.4%). Mean warm ischemia time (WIT) of total clamping, selective clamping, and early unclamping was 22.2 minutes, 21.2 minutes, and 17.3 minutes, respectively. Of patients with an eGFR < 60 (n = 90), 26.6% underwent minimal clamping, including 15.5 % early unclamping, 4.4% selective clamping and 6.7% off-clamp. Of patients with solitary kidneys (n = 12), ten (83%) were performed with total clamping with mean WIT of 14.9 minutes. CONCLUSION In this large international series of RPN for complex tumors, most patients underwent total clamping of the main renal artery. Minimal clamping techniques, including early unclamping, selective clamping, and off-clamp techniques, were used in a minority of cases. There was no significant increase in use of minimal clamping, even in patients with chronic kidney disease or solitary kidneys. However, mean WIT was low (<23 minutes) in all patient groups.
Journal of endourology. 2016 Dec 09 [Epub ahead of print]
Leedor Lieberman, Ravi Barod, Deepansh Dalela, Mireya Insua, Ronney Abaza, James Adshead, Rajesh Ahlawat, Benjamin Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A Moon, Giacomo Novara, Francesco Porpiglia, Alexandre Mottrie, Mahendra Bhandari, Craig G Rogers
Wayne State University School of Medicine, 12267, Detroit, Michigan, United States ; ., Henry Ford Hospital, Vattikuti Urology Institute , 2799 West Grand Boulevard , Detroit, Michigan, United States , 48202 ; ., Henry Ford Hospital, 24016, Vattikuti Urology Institute, Detroit, Michigan, United States ; ., Henry Ford Hospital, Vattikuti Urology Institute, Detroit, Michigan, United States ; ., Ohio Health, Robotic Urologic Surgery, Dublin, Ohio, United States ; ., Lister Hospital, 156688, Stevenage, Hertfordshire, United Kingdom of Great Britain and Northern Ireland ; ., Medanta The Medicity, 204687, Division of Urology and Renal Transplantation, Gurgaon, Haryana, India ; ., Guy's Hospital, Urology , London , London, United Kingdom of Great Britain and Northern Ireland , SE1 7RT ; ., MRC Centre for Transplantation, 215816, Vattikuti Institute of Robotic Surgery, London, London, United Kingdom of Great Britain and Northern Ireland ; ., Olv Vattikuti Robotic Surgery Institute, Urology , Melle , Aalst, Belgium , 9300 ; ., Peter MacCallum Cancer Institute, 3085, East Melbourne, Victoria, Australia ; ., University of Padua, Oncological and surgical sciences, Urology Clinic , Monoblocco Ospedaliero - IV Floor Via Giustiniani 2 , Padua, Italy , 35100 ; ., San Luigi Hospital, Urology , Regione Gonzole 10 , Orbassano, Italy , 10043 ; ., Onze Lieve Vrouwziekenhuis, 37467, Dep. of Urology, Aalst, Belgium ; ., Henry Ford Hospital, 24016, Vattikuti Urology Institute, Detroit, Michigan, United States ; ., Henry Ford Hospital, Vattikuti Urology Institute , 2799 West Grand Boulevard , Detroit, Michigan, United States , 48202.