Renal Function Outcomes After Soft-Coagulation Versus Robot-Assisted Partial Nephrectomy

We compared renal function outcomes between soft-coagulation-assisted open partial nephrectomy using an off-clamp technique and robot-assisted partial nephrectomy with temporary clamping for localized renal tumors.

A retrospective analysis was performed on 229 patients who underwent either soft-coagulation-assisted open partial nephrectomy (n = 47) or robot-assisted partial nephrectomy (n = 182). Renal function was evaluated by the percent change in estimated glomerular filtration rate at postoperative days 1 and 7, and months 1, 3, and 12. Multivariable linear regression was used to identify predictors of renal function decline.

Patients who underwent soft-coagulation-assisted open partial nephrectomy demonstrated significantly greater declines in renal function compared to those who underwent robot-assisted surgery at all evaluated time points. On postoperative day 1, the percent change in estimated glomerular filtration rate was -21.9% in the soft-coagulation group versus -11.9% in the robotic group (p = 0.0001). Similar trends were observed at postoperative day 7 (-10.2% vs. -5.4%, p = 0.027), month 1 (-12.7% vs. -5.0%, p = 0.0019), month 3 (-10.8% vs. -4.5%, p = 0.0025), and month 12 (-15.9% vs. -6.6%, p = 0.0007). Multivariable analysis revealed that robot-assisted surgery and younger age were independent predictors of better renal function preservation at 12 months.

Despite theoretical advantages in avoiding ischemia, soft-coagulation-assisted open partial nephrectomy resulted in greater renal function decline. Robot-assisted partial nephrectomy achieved superior preservation, likely due to enhanced surgical precision and minimized parenchymal injury.