Abstract
Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS) performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs (n = 44), which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR), respectively. Outcomes of the clamped (group 1, n = 14) versus off-clamp (group 2, n = 30) RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.
Highlights
Introduction and ObjectivesNephron-sparing surgery (NSS) has recently emerged as a viable alternative for small renal tumours in patients with a normal contralateral kidney, with encouraging long-term oncological outcomes [1, 2]
Group 1 consisted of the patients (n = 14) whose tumors were removed after clamping the renal hilum and the second group (n = 30) involved those who were managed with off-clamp Robot-assisted nephron-sparing surgery (RANSS)
Apart from a single patient in group 1, who had a tumor bearing solitary kidney, all nephron-sparing surgery decisions were based on elective indications
Summary
Nephron-sparing surgery (NSS) has recently emerged as a viable alternative for small renal tumours in patients with a normal contralateral kidney, with encouraging long-term oncological outcomes [1, 2]. Current guidelines advocate NSS as the ideal treatment of T1a tumors and an alternative treatment option for T1b tumors [3]. The utility of NSS has increased at many high volume centers over the past decade, approaching 90% for T1a tumors at some centers [4]. The more popular trend has been to perform NSS by minimally invasive approaches, which is a considerable challenge given concern about margin status and ischemia times [5, 6]. The use of robotics may facilitate minimally invasive NSS, and it is accepted as an attractive minimally invasive treatment option for amenable tumors
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