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Off-Clamp Robot-Assisted Partial Nephrectomy: How Far Shall We Proceed?

Ali Abdel Raheem1,2, Glen Denmer Santok1, Lawrence H C Kim1

  • 11 Department of Urology, Urological Science Institute, Yonsei University College of Medicine , Seoul, South Korea .

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|October 20, 2017
PubMed
Summary
This summary is machine-generated.

Off-clamp robot-assisted partial nephrectomy (RAPN) increases bleeding risk for tumors larger than 3.2 cm or with a PADUA score of 9 or higher. Significant blood loss (>400 mL) during RAPN predicts chronic kidney disease upstaging.

Keywords:
off-clamppartial nephrectomyrenal tumorroboticsurology

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • Off-clamp robot-assisted partial nephrectomy (RAPN) may lead to greater blood loss than the on-clamp method.
  • Identifying ideal tumor characteristics for off-clamp RAPN is crucial for surgical planning.

Purpose of the Study:

  • To demonstrate the surgical technique for off-clamp RAPN.
  • To identify tumor characteristics associated with increased intraoperative blood loss (EBL) during off-clamp RAPN.
  • To evaluate risk factors for significant EBL and chronic kidney disease (CKD) upstaging.

Main Methods:

  • Retrospective analysis of 62 patients undergoing off-clamp RAPN.
  • Receiver operating characteristic (ROC) analysis to determine cut-off values for tumor size and preoperative aspects and dimensions used for an anatomical (PADUA) score associated with increased EBL.
  • Logistic regression to assess risk factors for EBL >400 mL and CKD upstaging.

Main Results:

  • Tumor size >3.2 cm and PADUA score ≥9 were associated with increased EBL (>400 mL).
  • Patients with tumors >3.2 cm experienced longer operative times, higher EBL, and increased transfusion rates.
  • EBL >400 mL was the sole predictor of CKD upstaging (odds ratio: 6.704, P=.009).

Conclusions:

  • Off-clamp RAPN carries an increased risk of bleeding and transfusion for tumors >3.2 cm or with a PADUA score ≥9.
  • Significant EBL (>400 mL) during off-clamp RAPN is a risk factor for CKD upstaging, even with zero ischemia.
  • Larger prospective studies are needed to validate these findings.