TY  - EJOU
AU  - Krane, L. Spencer 
AU  - Mufarrij, Patrick W. 
AU  - Manny, Theodore B. 
AU  - Hemal, Ashok K. 

TI  - Comparison of clamping technique in robotic partial nephrectomy: does unclamped partial  nephrectomy improve perioperative outcomes  and renal function?
T2  - Canadian Journal of Urology

PY  - 2013
VL  - 20
IS  - 1
SN  - 1488-5581

AB  - <b>Introduction:</b> 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.<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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.<br/>
<b>Conclusions:</b> 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.
KW  - kidney
KW  -  robotics
KW  -  laparoscopy
KW  -  nephrectomy
KW  -  partial nephrectomy
KW  -  nephron sparing  surgery
KW  -  ischemia
KW  -  kidney cancer

DO  -