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Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living donor...

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Use of a Hanging-weight System for Isolated Renal Artery Occlusion
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Off-Clamp Versus On-Clamp Partial Nephrectomy: An Updated Systematic Review, Meta-Analysis and Meta-Regression.

Paweł Dębiński1, Jakub Karwacki2, Łukasz Nowak2

  • 1Department of Urology, University Centre of Excellence in Urology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland.

Journal of Clinical Medicine
|April 14, 2026
PubMed
Summary

Off-clamp partial nephrectomy (PN) better preserves kidney function and reduces positive surgical margins compared to on-clamp PN. However, off-clamp PN is associated with increased blood loss, supporting individualized surgical decisions.

Keywords:
ischemiakidney cancerpartial nephrectomyrenal function

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • The impact of renal ischemia during partial nephrectomy (PN) on postoperative renal function is debated.
  • On-clamp PN offers surgical advantages but induces warm ischemia, potentially impairing renal function.
  • Off-clamp PN avoids ischemia but raises concerns about blood loss and oncological safety.

Purpose of the Study:

  • To systematically compare perioperative and functional outcomes, and surgical margin status between on-clamp and off-clamp PN.
  • To evaluate the trade-offs between renal preservation, blood loss, and oncological outcomes in PN techniques.
  • To inform individualized surgical decision-making in nephron-sparing surgery.

Main Methods:

  • Systematic search of multiple databases (PubMed, Embase, Cochrane, Web of Science, Scopus) for RCTs and observational studies.
  • Inclusion of studies comparing on-clamp versus off-clamp PN with no publication time limitations.
  • Analysis of outcomes including estimated glomerular filtration rate (eGFR), blood loss, transfusion rates, surgical margins, operative time, and complications.

Main Results:

  • Off-clamp PN demonstrated a smaller decline in eGFR and lower percentage eGFR loss.
  • On-clamp PN was associated with lower estimated blood loss (EBL) but not statistically significant differences in transfusion rates.
  • On-clamp PN showed a higher risk of positive surgical margins (PSMs) and postoperative complications.

Conclusions:

  • Off-clamp PN offers superior renal functional preservation and reduced risks of PSMs and complications, albeit with increased blood loss.
  • Findings support individualized surgical decision-making based on patient and tumor characteristics.
  • Ischemia-free surgery (off-clamp PN) is advantageous for renal preservation and oncological control, with careful consideration of blood loss.