Selective renal parenchymal clamping in robot-assisted laparoscopic partial nephrectomy: a multi-institutional...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Robot-assisted laparoscopic partial nephrectomy (RALPN) is a standard treatment for renal tumors.
• Achieving hemostasis without compromising renal function remains a challenge.
• Selective renal ischemia techniques aim to minimize warm ischemia time and preserve kidney function.

Purpose of the Study:

• To evaluate the multi-institutional feasibility and outcomes of using a laparoscopic clamp for selective regional ischemia during RALPN.
• To assess the safety and efficacy of inducing regional ischemia without complete hilar occlusion.

Main Methods:

• Retrospective review of patients undergoing RALPN with selective regional clamping at four institutions.
• Analysis of operative times, clamping duration, complications, and oncological outcomes.
• Assessment of renal function using glomerular filtration rate (GFR) preoperatively and postoperatively.

Main Results:

• RALPN with parenchymal clamping was successful in 85% of 20 patients.
• Median operative time was 190 minutes, with a selective clamp time of 26 minutes.
• No significant difference in preoperative and postoperative GFR was observed. Renal cell carcinoma was confirmed in 71% of cases with no positive margins.

Conclusions:

• Selective regional ischemia using a laparoscopic parenchymal clamp is a feasible technique for hemostasis during RALPN.
• Careful preoperative patient and tumor selection is essential for successful application.
• Further comparative studies are warranted to establish the definitive utility of this approach.