Editorial Comment

Abstract

The authors retrospectively reviewed their early outcomes of 28 “off-clamp” robotic partial nephrectomies (RPNs), of which 12 (43%) were benign masses. The advantage of such an approach mainly relates to theoretical avoidance and prevention of ischemic insult to kidney. Previous work by White et al described outcomes of 8 patients who underwent off-clamp RPN compared with 20 patients treated by RPN with hilar occlusion. 1 White W.M. Goel R.K. Haber G.P. et al. Robotic partial nephrectomy without renal hilar occlusion. BJU Int. 2010; 105: 1580-1584 Crossref PubMed Scopus (49) Google Scholar They found significantly higher estimated blood loss rates in the off-clamp group; however, this did not translate into higher transfusion rates postoperatively. Although they used serum creatinine (SCr) levels to measure renal function, there was no significant difference in SCr before and after surgery in the off-clamp RPN group. Robotic Partial Nephrectomy Without Renal IschemiaUrologyVol. 79Issue 6PreviewTo evaluate our outcomes of robotic partial nephrectomy (RPN) without renal artery clamping (off-clamp), in order to avoid ischemic renal injury, using cold-scissor tumor excision and sutured reconstruction without ablation or other regional hypoperfusion. Full-Text PDF ReplyUrologyVol. 79Issue 6PreviewRobotic technology continues to push the limits of minimally invasive nephron-sparing surgery. The initial report of 8 off-clamp robotic partial nephrectomies (RPNs) by White et al demonstrated the feasibility of RPN without arterial clamping1; but by excluding hilar, endophytic, or multiple tumors and tumors >4 cm or in solitary kidneys, the full potential of robotic technology in performing off-clamp RPN was not explored. Although this initial report was appropriately judicious, we sought to build upon this work by reporting our further experience, applying off-clamp RPN in all of these situations, including those in which off-clamp RPN might be most beneficial. Full-Text PDF