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Published on: July 19, 2011
Off-clamp and on-clamp robotic-assisted partial nephrectomy in ischemia-sensitive patients: a multicenter propensity
Léo Schurdi-Levraud1, Gaëlle Margue2,3,4, Arna Geshkovska2,3
1Department of Urology, Andrology and Kidney Transplantation, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France - leo.schurdi-levraud@u-bordeaux.fr.
Minerva Urology and Nephrology
|July 13, 2026
Summary
Off-clamp robotic-assisted partial nephrectomy (RAPN) significantly benefits patients with a solitary kidney by reducing acute kidney injury and hospital stays. This off-clamp approach avoids warm ischemia, improving short-term renal function without compromising oncologic outcomes.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Robotic-assisted partial nephrectomy (RAPN) is a key treatment for kidney tumors.
- Ischemia during RAPN poses risks, especially for patients with compromised kidney function.
- Off-clamp (OfC) techniques aim to minimize ischemia during RAPN.
Purpose of the Study:
- To evaluate the impact of ischemia during RAPN in high-risk patients.
- To assess the benefits of OfC RAPN in patients with solitary kidney (SK) or chronic kidney disease (CKD).
- To compare post-operative renal function and perioperative outcomes between OfC and on-clamp (OnC) RAPN.
Main Methods:
- Retrospective analysis of RAPN cases from 16 centers (2011-2024).
- Inclusion of patients with SK or stage 3b CKD (eGFR ≤45 mL/min/m²).
- Propensity score matching was used to compare OfC RAPN and OnC RAPN outcomes, focusing on renal function evolution.
Main Results:
- OfC RAPN in SK patients showed less eGFR variation at day 1 and discharge compared to OnC RAPN.
- OfC RAPN significantly reduced acute kidney injury (AKI) incidence and length of hospital stay in SK patients.
- No significant differences were observed in complications, bleeding, recurrence, or positive margins. No significant benefits were found in the CKD subgroup.
Conclusions:
- OfC RAPN provides significant short-term functional benefits for ischemia-sensitive patients with a solitary kidney.
- Avoiding warm ischemia with OfC RAPN reduces AKI and shortens hospital stays.
- The OfC approach maintains oncologic safety and does not increase surgical morbidity.
