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World Journal of Urology

, Volume 33, Issue 6, pp 763–769 | Cite as

Clinical values of selective-clamp technique in robotic partial nephrectomy

  • Tae Young Shin
  • Sey Kiat Lim
  • Christos Komninos
  • Dong Wook Kim
  • Woong Kyu Han
  • Sung Jun Hong
  • Byung Ha Jung
  • Koon Ho RhaEmail author
Original Article

Abstract

Purpose

In the era of robotic partial nephrectomy (RPN), several efforts on improved renal functional outcome have been reported. Selective-clamp is a novel technique that eliminates global ischemia, the clinical value of which needs to be demonstrated. The purpose of this study was to compare the postoperative functional outcomes of patients who underwent selective-clamp and total-clamping RPN.

Patients and methods

From February 2009 to October 2012, a database of 126 consecutive patients who underwent RPN was retrospectively analyzed, 117 patients met our inclusion criteria and were stratified into two groups, 20 patients underwent selective-clamp RPN, and 97 patients underwent total-clamping RPN. Post hoc power analysis was subsequently performed for calculation of sufficient sample size. Demographics/tumor characteristics, functional outcomes and complications were analyzed.

Results

All selective-clamp RPN cases were successfully performed. Mean tumor size was 3.4 cm [standard deviation (SD): ±1.4], mean RENAL nephrometry score was 7.3 (SD: ±2.0), and no Clavien–Dindo III–V complications were recorded. Selective-clamp RPN group had a significantly lower percentage decrease in the postoperative estimated glomerular filtration rate at 1 week (1.8 vs. 20.8 ml/min/1.73 m2, p = 0.001) and 3 months (0 vs. 9.9 ml/min/1.73 m2, p = 0.032) when compared with the total-clamping RPN group. There were no significant differences in surgical margin and complication rates.

Conclusions

Selective-clamp confers improved renal functional outcomes in comparison to total-clamping RPN, with acceptable complications and oncological outcomes even in large and complex tumors.

Keywords

Partial nephrectomy Renal cell carcinoma Warm ischemia time 

Notes

Acknowledgments

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2012(6-2012-0181).

Conflict of interest

None.

Ethical standard

An institutional review board-approved protocol was implemented for data submission (IRB No.: 4-2009-0131).

Supplementary material

Supplementary material 1 (AVI 8111 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Tae Young Shin
    • 2
  • Sey Kiat Lim
    • 3
  • Christos Komninos
    • 4
  • Dong Wook Kim
    • 5
  • Woong Kyu Han
    • 1
  • Sung Jun Hong
    • 1
  • Byung Ha Jung
    • 1
  • Koon Ho Rha
    • 1
    Email author
  1. 1.Department of Urology, Urological Science InstituteYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Urology, Chuncheon Sacred HospitalHallym Medical CollegeChuncheonSouth Korea
  3. 3.Department of UrologyChangi General HospitalSingaporeSingapore
  4. 4.Department of UrologyGeneral Hospital of Nikaia ‘St. Panteleimon’AthensGreece
  5. 5.Biostatistics Collaboration UnitYonsei University College of MedicineSeoulSouth Korea

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