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Sutureless Purely Off-clamp Robotic Partial Nephrectomy: Evidence from a Randomized Controlled Noninferiority Trial.

Aldo Brassetti1, Gabriele Tuderti1, Umberto Anceschi1

  • 1Uro-Oncology Program, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

European Urology
|May 14, 2026
PubMed
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Sutureless off-clamp robotic partial nephrectomy (SL-ocRPN) is a safe and effective alternative to renorrhaphy (RR-ocRPN) for renal tumors, demonstrating noninferior surgical quality and preserving renal function.

Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Robotic partial nephrectomy aims to preserve renal function.
  • Sutureless techniques may reduce postoperative damage.
  • Assessing sutureless off-clamp robotic partial nephrectomy (SL-ocRPN) against renorrhaphy (RR-ocRPN) is crucial for surgical quality.

Purpose of the Study:

  • To evaluate if SL-ocRPN is noninferior to RR-ocRPN in terms of surgical quality.
  • To compare Trifecta achievement rates between SL-ocRPN and RR-ocRPN.
  • To assess secondary outcomes including complications and renal function preservation.

Main Methods:

  • A single-center, single-surgeon randomized controlled trial (NCT06846112) was conducted.
  • 248 patients with cT1-2N0M0 renal tumors were randomized 1:1 to SL or RR-ocRPN.
Keywords:
partial nephrectomyrandomized controlled trialrenorrhaphyroboticssutureless

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  • The primary endpoint was Trifecta achievement at discharge, analyzed using a noninferiority test.

    • Main Results:

    • Trifecta achievement was noninferior, with rates of 93% for SL-ocRPN and 95% for RR-ocRPN (p=0.006).
    • Blood transfusions and acute kidney injury were rare in both groups.
    • Urinary fistulae occurred more frequently in the SL group but were not statistically significant; renal function and recurrence-free survival were excellent.

    Conclusions:

    • SL-ocRPN is a safe and effective surgical option for selected renal tumors.
    • It offers a feasible alternative to RR-ocRPN, potentially minimizing functional damage.
    • Further research with longer oncologic follow-up is warranted.