Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

Abstract

Objective: To investigate the safety and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN). Methods: The clinical data of 38 patients with renal tumor who underwent modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative related indicators and postoperative renal function recovery were analyzed and compared between the two groups. Results: All patients (n = 116) finished the RAPN successfully, and none was transferred to radical and open surgery in both groups. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time node in the modified early unclamping group were higher than those in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis. Conclusion: The application of modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys, without increasing volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.