Clinical values of selective-clamp technique in robotic partial nephrectomy
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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.
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.
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.
KeywordsPartial nephrectomy Renal cell carcinoma Warm ischemia time
This study was supported by a faculty research grant of Yonsei University College of Medicine for 2012(6-2012-0181).
Conflict of interest
An institutional review board-approved protocol was implemented for data submission (IRB No.: 4-2009-0131).
Supplementary material 1 (AVI 8111 kb)
- 18.Nguyen MM, Gill IS (2008) Halving ischemia time during laparoscopic partial nephrectomy. J Urol 179:627–632; discussion 632Google Scholar