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Robot-assisted Partial Splenectomy
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Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial.
Barrett G Anderson1, Aaron M Potretzke2, Kefu Du3
1Department of Urology, Detroit Medical Center, Detroit, MI.
Urology
|January 20, 2019
Summary
Robot-assisted partial nephrectomy without warm ischemia (off-clamp) showed no significant difference in preserving kidney function compared to the on-clamp method. Surgeons can choose either approach based on patient factors and preference.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Robot-assisted partial nephrectomy (RARP) is a standard treatment for kidney tumors.
- The use of renal artery clamping (on-clamp) during RARP aims to minimize blood loss but may affect renal function.
- Off-clamp RARP aims to preserve renal function by avoiding ischemia.
Purpose of the Study:
- To compare postoperative renal functional outcomes between off-clamp and on-clamp RARP.
- To evaluate the safety and efficacy of both RARP techniques.
Main Methods:
- A prospective randomized trial involving 80 patients undergoing RARP.
- Patients were randomized to either on-clamp or off-clamp RARP.
- Renal function was assessed using estimated glomerular filtration rate and renal scintigraphy preoperatively and at 3 months postoperatively.
Main Results:
- Off-clamp RARP procedures were longer (178.0 minutes) than on-clamp (156.0 minutes).
- No significant differences were observed in estimated blood loss, complications, or positive margins between the groups.
- At 3-month follow-up, changes in estimated glomerular filtration rate and split renal function were similar for both on-clamp and off-clamp RARP.
Conclusions:
- Off-clamp RARP offers comparable perioperative outcomes to on-clamp RARP.
- No demonstrable benefit in renal function preservation was found with the off-clamp technique.
- The choice between on-clamp and off-clamp RARP can be based on surgeon preference and patient-specific factors, such as baseline renal insufficiency or solitary kidney.
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