Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp versus Standard On-Clamp Surgery

Abstract

Objectives: To evaluate a case-matched study comparing postoperative renal function using two surgical techniques: an off-clamp partial nephrectomy (PN) with the aid of the Altrus® device and a standard on-clamp laparoscopic PN. Material and Methods: A total of 36 patients underwent PN. Eighteen had the off-clamp technique and 18 had the standard laparoscopic on-clamp PN. Demographic, clinical, radiological, and perioperative data were collected for analysis. An emphasis on renal function was made by analyzing both the perioperative and follow-up with estimated glomerular filtration rate and MAG3. Results: The median values did not signifcantly differ for age, Charlson Comorbidity Index, and hospital stay in the off-clamp versus on-clamp PN [62.5 (interquartile range, IQR 11) vs. 60 (IQR 16) years, 4 (IQR 2) vs. 5 (IQR 2) and 5 (IQR 1) vs. 4 (IQR 2) days], respectively. The median diameter of the tumors was 33 (IQR 23) versus 41 (IQR 28) mm (p = 0.63), with median R.E.N.A.L. nephrometry scores of 7 (IQR 2) versus 7 (IQR 2) (p = 0.33). There was greater blood loss in the Altrus® (375 vs. 200 ml, p = 0.037). The clamp time in the on-clamp group was 30 (IQR 6) minutes (range 22-68 minutes) compared to 0 minutes in the off-clamp group. There was no difference in hemoglobin or creatinine levels between the groups. However, the on-clamp group had a significant loss in ipsilateral renal function on the MAG3 scan (49 vs. 42%, p = 0.0001), whereas the off-clamp group had no difference (48 vs. 46%, p = 0.72). Conclusions: The off-clamp method for PN is a feasible and safe option with better preservation of ipsilateral renal function when compared with on-clamp PN in the treatment of small renal masses.

Laparoscopic Partial Nephrectomy: Off-Clamp Versus on Clamp

“…The cold ischemia technique may offer more excellent kidney function protection, but it often prolongs the ischemic Laparoscopic Partial Nephrectomy: Off-Clamp Versus on Clamp off-clamp laparoscopic partial nephrectomy technique was used on a small number of patients. This technique was guided by the RENAL score and shown to prevent some of the incidents associated with hilar clamping during laparoscopic partial nephrectomy and renal hilar dissection and to completely prevent renal ischemic injury compared to conventional on-clamp laparoscopic partial nephrectomy (Antonelli, Veccia, et al, 2019;Aquil et al, 2020;Bove et al, 2019). Trehan (2014) conducted a meta-analysis to compare oncological outcomes, peri-and postoperative variables, surgical complications, and renal outcomes of on-clamp and off-clamp partial nephrectomy.…”