Editorial Comment to Randomized trials to determine the ideal management of the renal artery during partial nephrectomy: Life's under no obligation to give us what we expect

Abstract

Nowadays, with improved technologies/techniques, it would be unethical to set up a study that includes a treatment group undergoing long ischemia.The surgical urology community has made consistent efforts in the attempt of raising the level of evidence regarding the adoption of certain "unconventional" approaches during RPN, butquoting Margaret Mitchelllife's under no obligation to give us what we expect.As a conclusion, although published randomized trials would discourage the continued use of techniques to minimize ischemia, surgeon's preference plays a role. The possibility to choose is supported by the fact that, in the setting of randomized trials, selective or zero ischemia approaches scored comparable complications rates to that of standard main artery clamping.In contrast, appropriate indication, skills and technology are mandatory before embarking in minimized ischemia techniques.