Use of Main Renal Artery Clamping Predominates Over Minimal Clamping Techniques During Robotic Partial Nephrectomy for Complex Tumors.
Lieberman L, Barod R, Dalela D, Insua M, Abaza R, Adshead J, Ahlawat R, Challacombe B, Dasgupta P, Gandaglia G, Moon DA, Novara G, Porpiglia F, Mottrie A, Bhandari M, and Rogers CG. Use of main renal artery clamping predominates over minimal clamping techniques during robotic partial nephrectomy for complex tumors. J Endourol 2017; 31(2):149-152.
Journal of endourology / Endourological Society
INTRODUCTION: Hilar clamping is often performed to facilitate robotic partial nephrectomy (RPN). Minimal clamping techniques may reduce renal ischemia, including early unclamping, selective clamping, and off-clamp RPN. We assess the utilization of clamping techniques in a large international consortium of surgeons performing RPN for complex tumors.
METHODS: We retrospectively evaluated 721 patients with complex tumors, who underwent RPN at 11 centers worldwide between 2008 and 2014. Complex tumors were defined as renal masses with a nephrometry score >6. Total clamping was defined as complete clamping of the main renal artery. Minimal clamping techniques included early unclamping, selective clamping, and off-clamp RPN. Clamping techniques were additionally assessed in patients with estimated glomerular filtration rate (eGFR)(p < 0.05) were used to statistically analyze differences in mean warm ischemia time (WIT).
RESULTS: Most patients underwent complete clamping (75.1%). Minimal clamping (24.9%) included early unclamping (10.8%), selective clamping (8.7%), and off-clamp (5.4%). Mean WIT of total clamping, selective clamping, and early unclamping was 22.2, 21.2, and 17.3 minutes, respectively. Of patients with an eGFR <60 >(n = 90), 26.6% underwent minimal clamping, including 15.5% early unclamping, 4.4% selective clamping, and 6.7% off-clamp. Of patients with solitary kidneys (n = 12), 10 (83%) were performed with total clamping with mean WIT of 14.9 minutes.
CONCLUSIONS: In this large international series of RPN for complex tumors, most patients underwent total clamping of the main renal artery. Minimal clamping techniques, including early unclamping, selective clamping, and off-clamp techniques, were used in a minority of cases. There was no significant increase in use of minimal clamping, even in patients with chronic kidney disease or solitary kidneys. However, mean WIT was low (<23 >minutes) in all patient groups.
Medical Subject Headings
Adult; Aged; Constriction; Female; Glomerular Filtration Rate; Humans; Ischemia; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Renal Artery; Renal Insufficiency, Chronic; Retrospective Studies; Robotic Surgical Procedures