Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Abstract

Introduction: The aim of this study was to compare the outcomes of on-clamp and off-clamp robotic partial nephrectomy (RPN). Materials and Methods: The charts of all patients who underwent an RPN at 8 institutions between 2010 and 2014 were retrospectively reviewed. The patients who underwent an off-clamp RPN were matched to on-clamp RPN in a 1-4 fashion according to the following variables: RENAL score, tumor size and surgeon's experience. Pre-, intra-, and postoperative data were compared between both groups. Results: Among 525 RPN, 26 were performed off-clamp (5%). They were matched to 104 on-clamp RPN. The complications rate (15.5 vs. 7.7%, p = 0.53), major complications rate (4.9 vs. 3.9%; p = 0.82), and transfusions rate (0 vs. 4.9%; p = 0.58) did not differ significantly between the clamped and unclamped groups. Conversely, estimated blood loss was higher in the off-clamp group (266.4 vs. 284.6 mL, p = 0.048) and so was the rate of conversion to radical nephrectomy (0 vs. 7.7%, p = 0.04). Postoperative preservation of renal function was comparable in both groups. Conclusion: Off-clamp RPN is feasible for a small subgroup of renal tumors without increased risk of postoperative complications but at the cost of higher estimated blood loss and increased risk of conversion to radical nephrectomy.

Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

“…Thompson et al [21] and others who analyzed functional recovery after PN in solitary kidney concluded that for each minute of ischemia, there was 5-6% increase in the risk of renal function decline [21][22][23]. By contrast, Peyronnet et al [24] were not able to show a direct relationship between ischemia time and postoperative renal function preservation.…”

Impact of hospital volume and surgeon volume on robot‐assisted partial nephrectomy outcomes: a multicentre study

“…However, the use of arterial clamping (i.e. on‐clamp vs off‐clamp PN) , the use of the early unclamping technique , as well as the approach used (i.e. retroperitoneal vs transperitoneal), were recorded as surrogates of the surgical technique used in each centre.…”

Effectiveness and safety of partial nephrectomy—no ischemia vs. warm ischemia: Systematic review and meta-analysis

“…We included 13 observational studies, in which there was a description of functional and oncologic results in patients undergoing PN without ischemia compared with PN with warm ischemia [ 15 17 18 19 20 21 22 23 24 25 26 27 28 ], and one clinical trial [ 29 ] ( Table 1 ) [ 15 17 18 19 20 21 22 23 24 25 26 27 28 29 ].…”

“…For the other items, the evaluation yielded mostly a low risk of bias ( Fig. 2A, B) [15,[17][18][19][20][21][22][23][24][25][26][27][28]. For Andersen 2019, we found an unclear risk of bias for blinding since there was no clear description of this issue.…”