Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Comparison of clamping technique in robotic partial nephrectomy: does unclamped partial nephrectomy improve perioperative outcomes and renal function?

L. Spencer Krane, Patrick W. Mufarrij, Theodore B. Manny, Ashok K. Hemal

Department of Urology, Wake Forest University, Winston-Salem, North Carolina, USA
Address correspondence to Dr. Ashok K Hemal, Department of Urology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1094 USA

Canadian Journal of Urology 2013, 20(1), 6662-6667.

Abstract

Introduction: Partial nephrectomy without renal vascular occlusion has been introduced to improve outcomes in patients undergoing robotic partial nephrectomy (RPN). We prospectively evaluated unclamped RPN at our institution and compared this to other clamping techniques in a non-randomized fashion.
Materials and methods: Ninety-five consecutive patients who successfully completed RPN between June 2010 and October 2011 are included in this analysis. All RPNs were performed by a single surgeon. Clamping technique was artery and vein (AV), artery alone (AO), or unclamped (U), without hypotensive anesthesia. Clamping decision was based on surgeon preference and feasibility of minimizing ischemia. All patients had bilateral functional renal units.
Results: Eighteen (19%), 58 (61%), and 19 (20%) patients had AV, AO, and U technique, respectively. Preoperative characteristics including age (p = 0.43), body mass index (p = 0.40), and RENAL nephrometry distribution (p = 0.10) were similar. In AV and AO groups, mean warm ischemia times were 19 and 17 minutes, respectively, and were not significantly different between the two cohorts (p = 0.39). Mean glomerular filtration rate (GFR) and overall percentage decrease in GFR at last follow-up were (64, 69, 81; p = 0.12) and (6%, 6%, 2%; p = 0.79) for AV, AO, and U, respectively. Median follow-up for last serum creatinine was 113 days and was similar across all cohorts (p = 0.37). Complication rate (p = 0.37), positive margin rate (p = 0.84), and change in hemoglobin concentration postoperatively (p = 0.94) were also similar between cohorts.
Conclusions: Unclamped partial nephrectomy is possible in patients undergoing RPN. In this study, it does not significantly alter perioperative or postoperative renal function or complication rates. Minimal ischemia, irrespective of clamping technique, in patients with bilateral renal units does not appear to adversely affect intermediate-term renal function.

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