title: Partial clamping of the renal artery during robot-assisted laparoscopic partial nephrectomy: technique and initial outcomes.
abstract: OBJECTIVE
  We describe the feasibility of partial arterial clamping (PAC) during robot-assisted partial nephrectomy (RAPN).
  
  
  METHODS
  We undertook a retrospective study of five patients who underwent PAC vs 17 who underwent complete hilar clamping (CHC). Estimated blood loss (EBL), transfusion rate, operative/console time, warm ischemia time (WIT), pathology, and postoperative glomerular filtration rate (GFR) were compared.
  
  
  RESULTS
  PAC patients were older (P=0.002) and more likely to have had previous abdominal surgeries (P=0.032). PAC vs CHC was associated with higher median EBL (350 mL vs 75 mL, P=0.026), although there were no differences in blood transfusions (P=0.250). PAC was associated with shorter WIT (14 min vs 21 min, P=0.023). Positive margin rate and GFR change were similar.
  
  
  CONCLUSIONS
  PAC offers a simple and reproducible technique that limits WIT during RAPN. PAC was not associated with more transfusions or positive margins. Further study is warranted to determine the utility of PAC with larger tumor size as well as the long-term benefits on renal function.
authors.affiliation: Department of Urology, Georgetown University Hospital, Washington, DC, USA.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.forename: William D
authors.initials: WD
authors.lastname: Ulmer
authors.forename: Blakely A
authors.initials: BA
authors.lastname: Plaster
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Hua-Yin
authors.initials: HY
authors.lastname: Yu
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D003250:Constriction; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007677:Kidney Function Tests; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011300:Preoperative Care; D012077:Renal Artery / Q000503:physiopathology / Q000601:surgery*; D012371:Robotics; D013525:Surgical Instruments; D016896:Treatment Outcome