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Functional Outcomes after Selective Clamping in Robot-Assisted Partial Nephrectomy.

Kiyoshi Takahara1, Mamoru Kusaka2, Takuhisa Nukaya1

  • 1Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan.

Journal of Clinical Medicine
|October 14, 2022
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Summary

Selective clamping in robot-assisted partial nephrectomy (RAPN) did not improve kidney function preservation compared to full clamping. Full clamping was associated with significantly lower estimated blood loss.

Keywords:
estimated glomerular filtration raterobot-assisted partial nephrectomyselective clamping

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Robot-assisted partial nephrectomy (RAPN) is a standard procedure for kidney tumor removal.
  • Clamping strategies, including full and selective renal artery clamping, aim to minimize blood loss and preserve renal function.
  • The comparative benefits and risks of selective versus full clamping in RAPN require further elucidation.

Purpose of the Study:

  • To compare the perioperative outcomes and postoperative renal function between selective and full clamping during RAPN.
  • To assess the impact of clamping strategy on estimated blood loss (EBL) and estimated glomerular filtration rate (eGFR) preservation.

Main Methods:

  • Retrospective analysis of 372 patients undergoing RAPN between July 2010 and March 2021.
  • Propensity score matching to create comparable cohorts for full clamping (n=47) and selective clamping (n=47).
  • Comparison of surgical time, warm ischemia time, complication rates, EBL, and eGFR preservation at 6 and 12 months post-surgery.

Main Results:

  • No significant differences were found in surgical time, warm ischemia time, or complication rates between the groups.
  • Full clamping demonstrated significantly lower EBL (30 mL) compared to selective clamping (60 mL) (p=0.046).
  • Postoperative eGFR preservation ratios at 6 months (94.0% vs. 92.7%) and 12 months (92.0% vs. 91.6%) showed no significant intergroup differences.

Conclusions:

  • Selective clamping in RAPN is associated with higher EBL compared to full clamping.
  • Selective clamping does not offer a significant advantage in renal functional preservation over full clamping in a propensity-score-matched cohort.
  • Full clamping may be a preferable strategy in RAPN when considering blood loss and equivalent renal function outcomes.