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Robot-Assisted Kidney Transplantation

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Off-clamp robot-assisted partial nephrectomy for complex renal tumors.

Eric H Kim¹, Youssef S Tanagho, Gurdarshan S Sandhu

¹Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

Journal of Endourology

|July 14, 2012

Summary

Off-clamp robot-assisted partial nephrectomy (RAPN) is a safe and effective technique for complex kidney tumors, showing minimal impact on renal function. Further studies are needed to compare it with standard clamped RAPN.

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Published on: January 2, 2026

Area of Science:

Urology
Oncology
Nephrology

Background:

Robot-assisted partial nephrectomy (RAPN) is a standard treatment for kidney tumors.
Warm ischemia time (WIT) can negatively impact renal function after RAPN.
Off-clamp techniques aim to reduce or eliminate WIT during RAPN.

Purpose of the Study:

To present institutional experience with off-clamp RAPN.
To evaluate the safety and efficacy of off-clamp RAPN in complex renal tumors.
To assess renal functional outcomes after off-clamp RAPN.

Main Methods:

Retrospective review of 65 patients undergoing off-clamp RAPN.
Analysis of 26 complex tumors (hilar location, endophytic, multifocal).
Hilar vessels were dissected but not clamped; WIT was 0 minutes.

Main Results:

Mean tumor size 2.5 cm, nephrometry score 8.7.
One intraoperative complication (7%); mean blood loss 403 mL.
No WIT, minimal eGFR decrease (3.1 mL/min/1.73 m²), 96% negative margins.

Conclusions:

Off-clamp RAPN is safe and effective for complex tumors, despite higher blood loss.
Minimal renal function changes observed at ~6-month follow-up.
Longer follow-up and direct comparison with clamped RAPN are warranted.