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Use of Main Renal Artery Clamping Predominates over Minimal Clamping Techniques during Robotic Partial Nephrectomy for Complex Tumors

Research output: Contribution to journalArticle

Leedor Lieberman, Ravi Barod, Deepansh Dalela, Mireya Diaz-Insua, Ronney Abaza, James Adshead, Rajesh Ahlawat, Benjamin Challacombe, Prokar Dasgupta, Giogio Gandaglia, Daniel A. Moon, Giacomo Novara, Francesco Porpiglia, Alexandre Mottrie, Mahendra Bhandari, Craig Rogers

Original languageEnglish
Pages (from-to)149-152
Number of pages4
JournalJournal of Endourology
Volume31
Issue number2
Early online date11 Jan 2017
DOIs
Publication statusPublished - 1 Feb 2017

King's Authors

Abstract

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) <60 and in patients with a solitary kidney. Two-tailed t-tests (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.

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