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Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study
Benoit Peyronnet1, Zine-Eddine Khene, Benjamin Pradère
1Service d'Urologie, CHU Rennes, Rennes, France.
Urologia Internationalis
|April 6, 2017
Summary
Off-clamp robotic partial nephrectomy (RPN) is feasible for select renal tumors, showing similar complication rates to on-clamp RPN. However, it involves greater blood loss and a higher risk of conversion to radical nephrectomy.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Robotic partial nephrectomy (RPN) is a standard procedure for renal tumors.
- Comparing on-clamp and off-clamp techniques is crucial for optimizing outcomes.
Purpose of the Study:
- To compare the clinical outcomes of on-clamp versus off-clamp robotic partial nephrectomy (RPN).
Main Methods:
- Retrospective review of 525 RPN cases across 8 institutions (2010-2014).
- Matched 26 off-clamp RPN cases with 104 on-clamp RPN cases based on RENAL score, tumor size, and surgeon experience.
- Compared pre-, intra-, and postoperative data between the two groups.
Main Results:
- No significant differences in overall or major complication rates, or transfusion rates between groups.
- Off-clamp RPN demonstrated higher estimated blood loss (266.4 vs. 284.6 mL) and increased conversion to radical nephrectomy rates (7.7% vs. 0%).
- Postoperative renal function was comparable between on-clamp and off-clamp RPN.
Conclusions:
- Off-clamp RPN is a viable option for specific renal tumors, without increasing postoperative complications.
- This technique is associated with increased estimated blood loss and a higher likelihood of conversion to radical nephrectomy.
- Renal function preservation is maintained with the off-clamp approach.