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On-Clamp Versus Off-Clamp Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: A Retrospective
Stanila Stoeva-Grigorova1, Simeon Marinov2,3, Pavel Abushev3,4
1Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria.
Diagnostics (Basel, Switzerland)
|May 27, 2026
Summary
Robot-assisted partial nephrectomy (RAPN) using on-clamp or off-clamp strategies shows similar safety and effectiveness. Both methods achieve comparable outcomes for localized renal tumors, supporting their use in selected patients.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Robot-assisted partial nephrectomy (RAPN) is a standard nephron-sparing approach for localized renal tumors.
- Techniques include on-clamp (renal artery clamping) and off-clamp (no hilar clamping) methods.
- Limited comparative real-world data exists, often affected by non-randomized patient selection.
Purpose of the Study:
- To compare perioperative, functional, and early oncological outcomes of on-clamp versus off-clamp RAPN.
- To evaluate surgical quality using the Trifecta outcome.
- To analyze differences in baseline tumor characteristics and their impact on technique selection.
Main Methods:
- Retrospective single-center study of 146 patients undergoing RAPN (2020-2025).
- Patients allocated to on-clamp (n=108) or off-clamp (n=38) based on tumor factors and surgeon judgment.
- Analysis included RENAL nephrometry score, Trifecta outcome, perioperative data, and early renal function.
Main Results:
- Off-clamp RAPN used more for smaller tumors (p=0.008), with similar RENAL scores.
- Higher estimated blood loss in off-clamp group (260 vs. 110 mL; p<0.0001), but similar transfusion and complication rates.
- Trifecta achievement (91.0% vs. 96.8%; p=0.45) and early renal function were comparable between groups.
Conclusions:
- Both on-clamp and off-clamp RAPN offer comparable perioperative safety, functional outcomes, and early oncological results.
- Observed differences in patient selection reflect bias, not inherent treatment effects.
- Findings support the feasibility of both techniques in selected patients, emphasizing the need for prospective studies.
