Robotic partial nephrectomy without renal ischemia

To evaluate our outcomes of robotic partial nephrectomy (RPN) without renal artery clamping (off-clamp), in order to avoid ischemic renal injury, using cold-scissor tumor excision and sutured reconstruction without ablation or other regional hypoperfusion.

Between September 2009 and October 2010, patients who underwent off-clamp RPN for ≥1 tumors were reviewed from a prospective database. All procedures were performed by a single surgeon experienced in RPN. Indications included solitary kidney, multiple tumors in the same kidney, or electively when they it was possible.

Twenty-eight off-clamp RPNs were performed in 22 patients. Mean age and body mass index were 55 years (range 24-73) and 31 kg/m(2). Mean operative time was 183 minutes with mean blood loss of 274 mL. One patient required transfusion and was the only patient with Clavien grade II or higher complications (4.5%). Mean ± SD off-clamp tumor size on final pathology was 2.1 ± 1.1 cm (range 0.8-4.9) with mean RENAL nephrometry score of 6.25 (4a-9ph). For patients with additional tumors undergoing RPN with clamping, mean warm ischemia time was 12.1 minutes (range 7-19.3) for tumors of 4.6-10.5 cm. Twenty patients (91%) were discharged on postoperative day 1. All had negative margins. Mean preoperative, immediate postoperative, and 6-month postoperative estimated glomerular filtration rate were 89.8, 77.5, and 86.5 mL/min, respectively.

For selected patients and tumors, RPN without ischemia is feasible without ablation, energy resection, or regional hypoperfusion. Further experience is necessary to determine which patients are ideally suited.