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Off-Clamp Robotic-Assisted Partial Nephrectomy: Retrospective Comparative Analysis from a Large Italian Multicentric
Angelo Porreca1,2, Filippo Marino1, Davide De Marchi1
1Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy.
Cancers
|August 28, 2025
Summary
Off-clamp robotic-assisted partial nephrectomy (RAPN) is a safe and effective kidney cancer treatment. This approach preserves renal function and offers excellent oncologic outcomes, making it a strong alternative to on-clamp RAPN.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Renal masses require nephron-sparing surgical options.
- Robotic-assisted partial nephrectomy (RAPN) is increasingly used for kidney tumors.
- Minimizing ischemia-reperfusion injury is crucial for preserving renal function.
Purpose of the Study:
- To evaluate off-clamp robotic-assisted partial nephrectomy (RAPN) outcomes.
- To assess functional impact and oncologic efficacy of clampless RAPN.
- To compare off-clamp RAPN with on-clamp RAPN in high-volume centers.
Main Methods:
- Retrospective multicenter study of 563 patients undergoing off-clamp RAPN.
- Comparison with 244 patients undergoing on-clamp RAPN.
- Exclusion criteria: solitary kidneys, tumors >7 cm, prior renal surgery.
Main Results:
- Low complication rate (9.2%, Clavien-Dindo Grade I-II).
- Excellent renal function preservation (median eGFR decline 4.1%).
- Favorable oncologic control: 2.4% positive surgical margin, 0.36% recurrence at 12 months.
Conclusions:
- Off-clamp RAPN is a safe and effective nephron-sparing technique.
- It offers significant renal function preservation and oncologic efficacy.
- It is a viable alternative to on-clamp RAPN, minimizing ischemia-reperfusion injury.
