The application of off-clamping in robotic-assisted partial nephrectomy for the treatment of renal tumors

Abstract

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors. Methods From January 2015 to March 2017, the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively. There were 31 males and 17 females, and the mean age was 57 years (range: 23-84 years). The mean tumor size was 3.1 cm (range: 1.2-6.4 cm), with the upper, middle, and lower polar tumors account for 35.4%, 27.1%, and 37.5%, respectively. The clinical tumor stage was T1N0M0 in all 48 cases, according to the AJCC tumor staging system for renal cancer. Results RAPNs were performed successfully in all 48 cases, without conversion to open surgery. In those patients, the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases. The renal artery and vein was exposed, dissected, isolated and then clamped in 4 cases due to bleeding. The mean surgical time was 85 min (range: 75-185 min). The mean estimated blood loss was 134 ml (range: 60-270 ml), and no blood transfusion was needed. The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point. The mean time for renorrhaphy was 22 min (rang: 11-31 min). No intraoperative severe complications such as vascular injury, trauma of abdominal organ occurred. There were 5 complications, including 2 cases of hematuria, 2 cases of delayed healing of incision, and 1 case of pneumohypoderma. The pathological diagnosis included 40 cases of renal clear cell carcinoma, 3 cases of papillary renal cell carcinoma, and 5 cases of angiomyolipomas. No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months). Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors. It carries the benefits of less complication, quick recovery, and less ischemia reperfusion renal injury. Off-clamping RAPN would be suitable for those patients with solitary kidneys, renal insufficiency, and bilateral tumors. Key words: Robotic surgery; Partial nephrectomy; Off-clamping; Renal tumor