Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp...

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Partial nephrectomy (PN) is a standard treatment for small renal masses.
• Preserving renal function post-PN is crucial for long-term patient outcomes.
• Surgical techniques aim to minimize ischemia and maximize renal function preservation.

Purpose of the Study:

• To compare postoperative renal function between off-clamp PN using the Altrus® device and standard on-clamp laparoscopic PN.
• To evaluate the safety and feasibility of the off-clamp PN technique.
• To assess renal function using estimated glomerular filtration rate and MAG3 scans.

Main Methods:

• A case-matched study involving 36 patients undergoing PN (18 off-clamp, 18 on-clamp).
• Collection of demographic, clinical, radiological, and perioperative data.
• Analysis of perioperative and follow-up renal function via estimated glomerular filtration rate and MAG3 scans.

Main Results:

• No significant differences in patient demographics, Charlson Comorbidity Index, or hospital stay between groups.
• Tumor size and R.E.N.A.L. nephrometry scores were comparable.
• Off-clamp PN showed significantly better preservation of ipsilateral renal function (MAG3 scan: 48% vs. 46%) compared to on-clamp PN (49% vs. 42%, p=0.0001).
• Greater blood loss was observed in the off-clamp group (375 vs. 200 ml, p=0.037).
• Clamp time was 0 minutes for off-clamp PN versus 30 minutes for on-clamp PN.

Conclusions:

• Off-clamp partial nephrectomy with the Altrus® device is a feasible and safe surgical option.
• This technique demonstrates superior preservation of ipsilateral renal function compared to standard on-clamp PN.
• Off-clamp PN is recommended for the treatment of small renal masses.