Introduction: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN. Materials and Methods: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp. Results: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m², respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months. Conclusions: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.

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Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurrence and diseaseprogression in non-muscle invasive bladder cancer (NMIBC) patients. Methods: From 2006-2015, 348 NMIBC patients at Siriraj Hospital were recruited for this study. Tumor-recurrence was identified after the transurethral resection of bladder cancer (TUR-BT) and pathological confirmation of NMIBC, while stage-progression was defined as muscularis-propria invasion after pathological review or metastases. Cox proportional hazards models were used to assess the recurrence-free survival (RFS) and progression-free survival (PFS) rates. Results: Of the 348 patients, 86 (24.7%) received RASIs at the first TUR-BT. The median age was 68 years, and it was significantly older for the RASI cohort. No differences in the tumor characteristics of the groups were found. The median follow-up periods for tumor-recurrence and stage-progression were 2.3 and 3.7 years, respectively. Forty percent of the patients experienced tumor-recurrence, with the no-RASI cohort experiencing a significantly higher tumor-recurrence rate (46% versus 22%, p<0.001). The 5-year RFS rates were 54% and 78% for the no-RASI and RASI cohorts, respectively (p=0.001). Stage-progression was observed in 6% of the patients. The 5-year PFS rates were 87% and 97% for the no-RASI and RASI cohorts, respectively. On univariate and multivariate analyses, a tumor size ≥3 cm and tumor multifocality were associated with recurrent bladder cancer (p<0.02). On the other hand, the administration of RASIs was associated with a reduced recurrence (p≤0.002). Conclusion: Our study suggests that RASI administration might be a potential factor to prevent bladder cancer recurrence. Further study is needed to evaluate the effects of RASIs.

Objective: Transversus abdominis plane (TAP) block is a form of multimodal pain management in open abdominal surgery. Among patients who undergo kidney transplantation, their choice of painkillers is limited. This study aims to determine the efficacy of TAP block vs local infiltration in pain management after kidney transplantation.Materials and Methods: In this prospective, randomized, double-blinded clinical trial, 46 patients with end-stage kidney disease who had undergone kidney transplantation were randomly divided into two groups: a local anesthetic infiltration (LA) group receiving 0.25% Bupivacaine 20 ml around the surgical wound before wound closure and a TAP block group receiving 0.25% Bupivacaine 20 ml by the inside-out technique. Their postoperative pain scores and morphine consumption were recorded at 2, 6, 12, 18, 24, and 48 hours.Results: There was no statistically significant difference in the baseline characteristics between the groups. The postoperative pain score at two hours in the TAP block group was significantly lower than in the LA group (P value = 0.037), but without other differences in their pain scores after two hours. There was no statistical difference in the morphine consumption between the two groups. The total morphine consumption in the TAP block group was less than in the LA group, but this was not statistically significant. No patients suffered from complications of the TAP block.Conclusion: Transversus abdominis plane block can reduce postoperative pain at two hours after kidney transplantation, without significant complications.