[Off-Clamp, Non-Renorrhaphy Robot-Assisted Partial Nephrectomy : An Initial Experience in a Single Institution]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) is a standard procedure for kidney tumors.
• Traditional RAPN often involves renal artery clamping and renorrhaphy, potentially impacting renal function.
• Alternative techniques aim to minimize warm ischemia time and surgical complexity.

Purpose of the Study:

• To evaluate the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy RAPN.
• To assess the feasibility and safety of this modified RAPN technique.

Main Methods:

• A retrospective review of 76 patients who underwent RAPN between February 2015 and August 2017.
• Seven patients underwent an off-clamp, non-renorrhaphy approach based on tumor location.
• Tumor enucleation, soft-coagulation system for hemostasis, and TachoSil® application were utilized.
• Renorrhaphy was generally omitted.

Main Results:

• The off-clamp, non-renorrhaphy RAPN was performed in 7 selected patients.
• Median patient age was 67 years, with a median tumor size of 14 mm.
• Average operative time was 139 minutes, console time 51 minutes, and estimated blood loss 10 ml.
• No perioperative blood transfusions were required.
• No pseudoaneurysms or urine leakage occurred.
• No complications above Clavien-Dindo grade 1 were observed.
• No positive surgical margins were reported.
• Median estimated glomerular filtration rate (eGFR) change at 3 months was 0%.

Conclusions:

• Off-clamp, non-renorrhaphy RAPN using a soft-coagulation system and TachoSil® is a feasible and safe surgical option.
• This technique is particularly suitable for carefully selected patients with superficial renal tumors.
• The procedure demonstrated excellent hemostasis and oncological outcomes without significant complications.