Clinical values of selective-clamp technique in robotic partial nephrectomy

Area of Science:

• Urology
• Surgical Innovation
• Renal Function Preservation

Background:

• Robotic partial nephrectomy (RPN) is a standard surgical approach for kidney tumors.
• Minimizing ischemia during RPN is crucial for preserving renal function.
• Selective-clamp technique aims to reduce global ischemia compared to total-clamping.

Purpose of the Study:

• To compare the postoperative renal functional outcomes between selective-clamp RPN and total-clamping RPN.
• To evaluate the clinical value of the selective-clamp technique in RPN.

Main Methods:

• Retrospective analysis of 117 patients undergoing RPN between February 2009 and October 2012.
• Patients were divided into two groups: 20 undergoing selective-clamp RPN and 97 undergoing total-clamping RPN.
• Comparison of demographics, tumor characteristics, functional outcomes (estimated glomerular filtration rate), and complications.

Main Results:

• Selective-clamp RPN demonstrated a significantly lower percentage decrease in estimated glomerular filtration rate at 1 week (1.8 vs. 20.8 ml/min/1.73 m(2)) and 3 months (0 vs. 9.9 ml/min/1.73 m(2)) compared to total-clamping RPN.
• No significant differences were observed in surgical margin status or complication rates between the two groups.
• All selective-clamp RPN procedures were technically successful, with no Clavien-Dindo III-V complications.

Conclusions:

• Selective-clamp RPN offers superior renal functional outcomes compared to total-clamping RPN.
• The technique is associated with acceptable oncological outcomes and complication rates, even for large and complex renal tumors.
• Selective-clamp RPN represents a valuable advancement in preserving kidney function during robotic partial nephrectomy.