Off-clamp robot-assisted partial nephrectomy not superior to on-clamp technique: Study
St. Louis, MO: When compared to on-clamp partial nephrectomy, off-clamp robot-assisted partial nephrectomy had similar perioperative results. There was no evidence of a benefit in terms of maintaining renal function says an article published in the journal Urology.
In view of mounting evidence that partial nephrectomy (PN) is linked with equivalent oncological outcomes, lower incidence of chronic kidney disease (CKD), and higher overall survival when compared to radical nephrectomy, PN is gaining favor over radical nephrectomy.
Barrett G Anderson and colleagues undertook this study to see if doing robot-assisted partial nephrectomy without thermal ischemia "off-clamp" lead to better postoperative kidney functional outcomes than using the on-clamp approach.
A prospective study of 80 patients who had partial nephrectomy with robot assistance was done. They were randomly assigned to have the operation with or without renal artery clamping in a 1:1 ratio. Demographics, surgical information, perioperative outcomes, and postoperative renal function were compared between the groups. Preoperatively and three months later, renal function was examined using the estimated glomerular filtration rate and renal scintigraphy.
The results of this study stated as follow:
1. Age, gender, BMI, comorbidities, clinical tumor size, nephrometry score, and laterality were all identical in the on-clamp and off-clamp groups.
2. Off-clamp operations took an average of 178.0 minutes compared to 156.0 minutes for on-clamp procedures.
3. Blood loss was estimated to be the same, as were postoperative complications, rates of pelvicalyceal repair, and positive margins.
4. There were no significant differences in change in postoperative estimated glomerular filtration rate or percent split renal function between the two groups after a median 3-month follow-up.
In conclusion, the insignificant crossover rate in this research is noteworthy, and the surgeons were presumably high-volume and well-versed in the problems of both methods. Urologists should not feel forced to conduct on-clamp partial nephrectomy vs off-clamp partial nephrectomy based on renal functional outcomes. Depending on the surgeon's discretion and patient-specific circumstances such as baseline renal insufficiency, numerous masses, or a solitary kidney, urologists can safely use either an on-clamp or off-clamp method.
Reference:
Anderson BG, Potretzke AM, Du K, Vetter JM, Bergeron K, Paradis AG, Figenshau RS. Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial. Urology. 2019 Apr;126:102-109. doi:10.1016/j.urology.2018.11.053. Epub 2019 Jan 16. PMID: 30659901.
