title: Do we need to clamp the renal hilum liberally during the initial phase of the learning curve of robot-assisted nephron-sparing surgery?
abstract: OBJECTIVE
  We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS) performed with or without hilar clamping.
  
  
  METHODS
  Charts of the initial RANSSs (n = 44), which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR), respectively. Outcomes of the clamped (group 1, n = 14) versus off-clamp (group 2, n = 30) RANSSs were compared.
  
  
  RESULTS
  The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥ 2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months.
  
  
  CONCLUSIONS
  Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.
authors.affiliation: Department of Urology, VKF American Hospital, 34365 Istanbul, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Acar
authors.affiliation: Department of Urology, VKF American Hospital, 34365 Istanbul, Turkey ; School of Medicine, Koc University, 34450 Istanbul, Turkey.
authors.forename: Tarık
authors.initials: T
authors.lastname: Esen
authors.affiliation: Department of Urology, VKF American Hospital, 34365 Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Musaoğlu
authors.affiliation: Department of Radiology, VKF American Hospital, 34365 Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Vural
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000098:blood supply; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome