title: Comparison of clamping technique in robotic partial nephrectomy:  does unclamped partial nephrectomy improve perioperative outcomes and renal function?
abstract: BACKGROUND
  Partial nephrectomy without renal vascular occlusion has been introduced to improve outcomes in patients undergoing robotic partial nephrectomy (RPN). We prospectively evaluated unclamped RPN at our institution and compared this to other clamping techniques in a non-randomized fashion.
  
  
  METHODS
  Ninety-five consecutive patients who successfully completed RPN between June 2010 and October 2011 are included in this analysis. All RPNs were performed by a single surgeon. Clamping technique was artery and vein (AV), artery alone (AO) or unclamped (U) without hypotensive anesthesia. Clamping decision was based on surgeon preference and feasibility of minimizing ischemia. All patients had bilateral functional renal units.
  
  
  RESULTS
  Eighteen (19%), 58 (61%) and 19 (20%) patients had AV, AO and U technique respectively. Preoperative characteristics including age (p = 0.43), body mass index (p = 0.40) and RENAL nephromety distribution (p = 0.10) were similar. In AV and AO, mean warm ischemia time were 19 and 17 minutes and similar between the two cohorts (p = 0.39). Mean glomerular filtration rate (GFR) and overall percentage decrease in GFR at time of at last follow up were (64, 69, 81, p = 0.12) and (6%, 6%,and 2%,p = 0.79) for AV, AO and U respectively. Median follow up for last serum creatinine was 113 days and was similar between all cohorts (p = 0.37). Complication rate (p = 0.37), positive margin rate (p = 0.84), and change in hemoglobin concentration postoperatively (p = 0.94) were similar between cohorts.
  
  
  CONCLUSIONS
  Unclamped partial nephrectomy is possible in patients undergoing RPN. In this study, it does not significantly alter perioperative or postoperative renal function or change rate of complications. Minimal ischemia, irrespective of clamping technique, in patients with bilateral renal units does not appear to adversely effect intermediate term renal function in these patients.
authors: Department of Urology, Wake Forest University, Winston-Salem, North Carolina 27157-1094, USA.
authors: L Spencer
authors: LS
authors: Krane
authors: Patrick W
authors: PW
authors: Mufarrij
authors: Theodore B
authors: TB
authors: Manny
authors: Ashok K
authors: AK
authors: Hemal
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003250:Constriction; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D007668:Kidney / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D059351:Organ Sparing Treatments; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012077:Renal Artery; D012082:Renal Veins; D012371:Robotics; D052096:Warm Ischemia / Q000009:adverse effects
chemical_list: D003404:Creatinine