Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 25;11(19):5648.
doi: 10.3390/jcm11195648.

Functional Outcomes after Selective Clamping in Robot-Assisted Partial Nephrectomy

Kiyoshi Takahara  1 , Mamoru Kusaka  2 , Takuhisa Nukaya  1 , Masashi Takenaka  1 , Kenji Zennami  1 , Manabu Ichino  1 , Hitomi Sasaki  1 , Makoto Sumitomo  1 , Ryoichi Shiroki  1
Affiliations

Functional Outcomes after Selective Clamping in Robot-Assisted Partial Nephrectomy

Kiyoshi Takahara et al. J Clin Med. .

Abstract

This study aimed to assess the risks and benefits of selective clamping in robot-assisted partial nephrectomy (RAPN). We retrospectively analyzed 372 patients who had undergone RAPN at our hospital between July 2010 and March 2021. After propensity score matching between the full and selective clamping groups, perioperative outcomes and postoperative preservation ratio of the estimated glomerular filtration rate (eGFR) were compared at 6 and 12 months of follow-up. After propensity score matching, we evaluated 47 patients from each group. While no significant differences were observed in surgical time, warm ischemia time, or incidence rates of all grades of complications between the two cohorts, the estimated blood loss (EBL) was significantly lower in the full clamping group than in the selective clamping group (30 vs. 60, p = 0.046). However, no significant intergroup differences were observed in the postoperative preservation ratio of eGFR at 6 or 12 months of follow-up (full clamping 94.0% vs. selective clamping 92.7%, p = 0.509, and full clamping 92.0% vs. selective clamping 91.6%, p = 0.476, respectively). Selective clamping resulted in higher EBL rates than did full clamping in RAPN. However, selective clamping provided no renal functional advantage over full clamping in our propensity-score-matched cohort.

Keywords: estimated glomerular filtration rate; robot-assisted partial nephrectomy; selective clamping.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the patients in the study.
Figure 2
Figure 2
Patients’ functional outcomes. (A) 6 months; (B) 12 months. Full clamping vs. selective clamping, mean with standard deviation.
Figure 3
Figure 3
Preservation ratio of eGFR. Category of WIT<16 min ((A) 6 months, (B) 12 months). Category of WIT>16 min ((C) 6 months, (D) 12 months). Full clamping vs. selective clamping, mean with standard deviation.
See this image and copyright information in PMC

References

    1. Scosyrev E., Messing E.M., Sylvester R., Campbell S., Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: Results from EORTC randomized trial 30904. Eur. Urol. 2014;65:372–377. doi: 10.1016/j.eururo.2013.06.044. - DOI - PubMed
    1. Van Poppel H., Da Pozzo L., Albrecht W., Matveev V., Bono A., Borkowski A., Colombel M., Klotz L., Skinner E., Keane T., et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur. Urol. 2011;59:543–552. doi: 10.1016/j.eururo.2010.12.013. - DOI - PubMed
    1. Cacciamani G.E., Medina L.G., Gill T., Abreu A., Sotelo R., Artibani W., Gill I.S. Impact of Surgical Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis. J. Urol. 2018;200:258–274. doi: 10.1016/j.juro.2017.12.086. - DOI - PubMed
    1. Thompson R.H., Lane B.R., Lohse C.M., Leibovich B.C., Fergany A., Frank I., Gill I.S., Blute M.L., Campbell S.C. Renal function after partial nephrectomy: Effect of warm ischemia relative to quantity and quality of preserved kidney. Urology. 2012;79:356–360. doi: 10.1016/j.urology.2011.10.031. - DOI - PubMed
    1. Badani K.K., Kothari P.D., Okhawere K.E., Eun D., Hemal A., Abaza R., Porter J., Lovallo G., Ahmed M., Munver R., et al. Selective clamping during robot-assisted partial nephrectomy in patients with a solitary kidney: Is it safe and does it help? BJU Int. 2020;125:893–897. doi: 10.1111/bju.15043. - DOI - PubMed