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Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and
Antonio Franco1, Sara Riolo1, Giorgia Tema1
1Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00185 Rome, Italy.
Abstract:
The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.
Insights
Sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN) is a safe and effective procedure for kidney tumors. This technique shows minimal impact on overall kidney function, preserving oncological outcomes with few complications.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Robot-assisted partial nephrectomy (RAPN) is a standard treatment for renal masses.
- Sutureless off-clamp techniques aim to improve outcomes and reduce complications.
- Evaluating the impact of sutureless off-clamp RAPN (sl-oc RAPN) on renal function is crucial.
Purpose of the Study:
- To assess the effectiveness and safety of sl-oc RAPN.
- To specifically evaluate the impact of sl-oc RAPN on renal function.
- To analyze oncological outcomes and perioperative complications.
Main Methods:
- A multicenter study involving 21 patients with renal masses (>2 cm, PADUA score ≤6).
- Patients underwent sl-oc RAPN.
- Renal function was assessed preoperatively and at 1 and 3 months post-surgery using creatinine, blood urea nitrogen, and sequential renal scintigraphy.
Main Results:
- The median patient age was 64 years, with a median tumor diameter of 40 mm.
- Operative time averaged 90 minutes, with estimated blood loss of 150 mL.
- A statistically significant median decrease in renal function of 10 mL/min was observed (p < 0.01), with renal scintigraphy showing a median decrease of 12% in the operated kidney.
Conclusions:
- Sutureless off-clamp robot-assisted partial nephrectomy is a safe procedure.
- The technique demonstrates a minimal impact on renal function alteration.
- sl-oc RAPN effectively preserves renal function and achieves optimal oncological outcomes with limited complications.
