Off-Clamp Robot-Assisted Partial Nephrectomy: How Far Shall We Proceed?

Raheem, Ali Abdel; Santok, Glen Denmer; Kim, Lawrence H C; Chang, Kihun; Lum, Trenton G.; Yoon, Young Eun; Han, Woong Kyu; Choi, Young Deuk; Rha, Koon Ho

doi:10.1089/lap.2017.0464

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Several techniques have been developed to achieve better renal function, such as segmental artery clamping, super selective embolization, and radiofrequency and microwave ablation ( 7 , 17 ). In recent years, zero ischemic LPN has introduced to eliminate WI injury and has been popularized among the urologic communities ( 18 - 20 ).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional reconstruction facilitates off-clamp laparoscopic partial nephrectomy for stage cT1b renal tumors

Wu¹,

Shen²,

Wu³

et al. 2020

Transl Cancer Res TCR

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Background: This study aimed to evaluate the role of three-dimensional (3D) reconstruction of T1b renal tumors in the off-clamp laparoscopic partial nephrectomy (LPN). Methods: A total of 40 consecutive patients undergoing LPN for stage cT1b renal tumor between January 2018 and July 2018 were included. Twenty received off-clamp LPN under the guidance of 3D reconstruction (3D group), and remaining 20 underwent off-clamp LPN under the guidance of conventional computer tomography arteriography (CTA group). The demographics, perioperative characteristics and renal function were compared between groups.Results: All the procedures were performed successfully without conversion to main renal artery clamping.There were no significant differences in the age, gender, body mass index (BMI), tumor size, and RENAL score between two groups. The mean operation time (OT) was significantly shorter and estimated blood loss markedly less in the 3D group than in the CTA group. Incidence of postoperative complications was 5% in the 3D group and 10% in the CTA group (P>0.05). 3D reconstruction of renal tumors resulted in more accurate dissection of the tumor artery (90.9%) as compared to conventional CTA (81.5%). All the patients had negative surgical margins. There was no significant difference in the estimated glomerular filtration rate (eGFR) before and after surgery between two groups.Conclusions: 3D reconstruction is beneficial for the resection of cT1b renal tumor and tumor-specific feeding arteries in the off-clamp LPN.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional reconstruction facilitates off-clamp laparoscopic partial nephrectomy for stage cT1b renal tumors

Wu¹,

Shen²,

Wu³

et al. 2020

Transl Cancer Res TCR

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“…Abdel Raheem et al27 evaluated 62 Off-C RPN patients in their study to determine the cutoff value of the amount of bleeding and related chronic kidney disease (CKD) development according to the tumor size and the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score. PADUA is an anatomical scoring system according to tumor size and location.…”

Section: Introductionmentioning

confidence: 99%

“…This study demonstrated that patients with PADUA score ≥9 and tumor size >3.2 cm are associated with an increased risk of intraoperative bleeding and perioperative blood transfusion. In addition, EBL volume of >400 mL is associated with CKD upstaging despite the application of zero ischemia 27…”

Section: Introductionmentioning

confidence: 99%

“…Zero ischemia PN is a surgically demanding procedure associated with the risk of increased intraoperative bleeding 24,27. Colli et al50 reported that postoperative decrease in hematocrit is associated with impaired RF at day 1 and 6 months postoperatively.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, Abdel Raheem et al27 reported a study that evaluated Off-C RPN patients to determine the cutoff value for the amount of bleeding and related CKD development according to the tumor size and PADUA score. The median follow-up period was 20 months.…”

Section: Introductionmentioning

confidence: 99%

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<p>Long-term renal function following zero ischemia partial nephrectomy</p>

Boğa

Sönmez

2019

RRU

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Partial nephrectomy (PN), also known as nephron sparing surgery, is considered as the first-line treatment in small renal masses, especially in T1/2 tumors, and is applied as a standard treatment in advanced centers. The main expected outcomes from an ideal PN are surgical margin negativity, minimal impairment in renal function, and any surgical complications. Many authors have defined PN techniques as “zero ischemia partial nephrectomy”, where surgery is performed without clamping the main renal artery in order to protect the renal parenchyma from ischemic injury. Various PN techniques employed by surgeons include: selective or segmental renal artery clamping technique; off-clamp, clampless, or unclamped technique; preoperative superselective transarterial tumor embolization technique; sequential/modified sequential preplaced suture renorrhaphy technique, radio frequency ablation-assisted technique, and combination of these techniques. The common goal of all these techniques is to provide zero ischemia without hilar clamping. This systematic review focuses on the long-term functional outcomes of PNs performed by zero ischemia techniques.

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