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Off-clamp and on-clamp robotic-assisted partial nephrectomy in ischemia-sensitive patients: a multicenter propensity score-matched study (RAPN OFF-CLAMP study - UroCCR 187).

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Sutureless robotic-assisted partial nephrectomy: a propensity score-matched analysis (UroCCR N.158).

Alexandre Blanco1, Gaëlle Margue2,3,4, Mokrane Yacoub5

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Sutureless techniques in off-clamp robot-assisted partial nephrectomy (RAPN) improve early renal function and reduce operative time compared to standard renorrhaphy. This approach is safe and effective for selected patients, without compromising oncological outcomes.

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Sutureless (SL) techniques offer an alternative to standard renorrhaphy (RR) in robot-assisted partial nephrectomy (RAPN).
  • SL techniques aim to mitigate adverse effects of parenchymal suturing on renal function, particularly in off-clamp procedures.
  • This study compares perioperative, functional, and oncological outcomes of SL versus RR in off-clamp RAPN.

Purpose of the Study:

  • To compare the efficacy and safety of sutureless versus renorrhaphy techniques in off-clamp robot-assisted partial nephrectomy.
  • To evaluate trifecta achievement, defined by negative surgical margins, absence of major complications, and preserved renal function.
  • To assess the impact on perioperative outcomes, including blood loss and operative time.

Main Methods:

  • A matched cohort study using data from the UroCCR database (June 2020 - March 2024).
  • 410 off-clamp RAPN cases were analyzed, with 112 in the SL group and 298 in the RR group.
  • Propensity score matching (2:1) based on R.E.N.A.L. nephrometry score was performed for comparison.

Main Results:

  • After matching, 112 SL and 224 RR cases were compared.
  • Trifecta achievement was significantly higher in the SL group (66.1% vs. 43.3%, P<0.001), driven by improved early renal function.
  • SL group showed reduced blood loss (103 vs. 344 mL, P<0.001), shorter operative time (145 vs. 176 min, P=0.001), and fewer intraoperative complications (0.9% vs. 5.4%, P=0.04).

Conclusions:

  • Omitting renorrhaphy in selected off-clamp RAPN cases is safe and effective.
  • Sutureless techniques enhance early functional outcomes and reduce operative time.
  • Perioperative morbidity is not increased, and oncological safety is maintained with sutureless approaches.