Comparison of selective parenchymal clamping to hilar clamping during robotic-assisted laparoscopic partial nephrectomy.
OBJECTIVE
To compare perioperative outcomes after robotic-assisted laparoscopic partial nephrectomy (RALPN) with hilar clamping vs parenchymal clamping.


METHODS
A retrospective, single-institution review of the patients undergoing RALPN with hilar or parenchymal clamping was performed. Associations between perioperative factors and clinicopathologic outcomes were determined using the t test, Fisher's exact test, and multivariate linear regression.


RESULTS
In 51 patients undergoing RALPN, 36 (71%) and 15 (29%) were performed with hilar and parenchymal clamping, respectively. Median tumor diameter was 2.8 cm for both groups (range, 1.1-6.1; P = .93). Tumor complexity by nephrometry score was mild (69% vs 80%), moderate (29% vs 20%), and high (2% vs 0%) in the respective groups (P = .65). Operative time was significantly shorter in the parenchymal clamp group (median 245 vs 320 minutes; P <.0001). There was no difference in blood loss and need for transfusion. On multivariate analysis, hilar clamping (P <.01), higher body mass index (P = .01), and higher complexity tumors (P = .02) were significantly associated with longer operative times. The parenchymal clamp group had better preservation of immediate postoperative glomerular filtration rate (GFR) from baseline to postoperative day 2 (median ΔGFR 0 vs -18 mL/min/1.73 m(2), P = .02). These differences from baseline did not persist (median ΔGFR -6 vs -7 mL/min/1.73 m(2), P = .35) at a median follow-up of 6.6 months. Final pathology determination of malignancy (P = .51) and positive margin rates (P = .26) were similar in both groups.


CONCLUSIONS
Compared with hilar clamping, selective regional ischemia with the parenchymal clamp for mild-moderately complex tumors is feasible and safe during RALPN. Parenchymal clamping is associated with enhanced immediate preservation of GFR and shorter operative times.
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Ryan S
RS
Hsi
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Liam C
LC
Macleod
Department of Urology, University of Washington School of Medicine, Seattle, WA.
John L
JL
Gore
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Jonathan L
JL
Wright
Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: jdharper@uw.edu.
Jonathan D
JD
Harper
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D055815:Young Adult