Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique.

The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.

Diagnostics (Basel, Switzerland). 2024 Jul 23*** epublish ***

Antonio Franco, Sara Riolo, Giorgia Tema, Alessio Guidotti, Aldo Brassetti, Umberto Anceschi, Alfredo Maria Bove, Simone D'Annunzio, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Salvatore Guaglianone, Gabriele Tuderti, Costantino Leonardo, Antonio Cicione, Leslie Claire Licari, Eugenio Bologna, Rocco Simone Flammia, Antonio Nacchia, Alberto Trucchi, Riccardo Lombardo, Giorgio Franco, Andrea Tubaro, Giuseppe Simone, Cosimo De Nunzio

Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00185 Rome, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy., Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, 00185 Rome, Italy.