title: Clinical values of selective-clamp technique in robotic partial nephrectomy.
abstract: OBJECTIVE
  In the era of robotic partial nephrectomy (RPN), several efforts on improved renal functional outcome have been reported. Selective-clamp is a novel technique that eliminates global ischemia, the clinical value of which needs to be demonstrated. The purpose of this study was to compare the postoperative functional outcomes of patients who underwent selective-clamp and total-clamping RPN.
  
  
  METHODS
  From February 2009 to October 2012, a database of 126 consecutive patients who underwent RPN was retrospectively analyzed, 117 patients met our inclusion criteria and were stratified into two groups, 20 patients underwent selective-clamp RPN, and 97 patients underwent total-clamping RPN. Post hoc power analysis was subsequently performed for calculation of sufficient sample size. Demographics/tumor characteristics, functional outcomes and complications were analyzed.
  
  
  RESULTS
  All selective-clamp RPN cases were successfully performed. Mean tumor size was 3.4 cm [standard deviation (SD): ±1.4], mean RENAL nephrometry score was 7.3 (SD: ±2.0), and no Clavien-Dindo III-V complications were recorded. Selective-clamp RPN group had a significantly lower percentage decrease in the postoperative estimated glomerular filtration rate at 1 week (1.8 vs. 20.8 ml/min/1.73 m(2), p = 0.001) and 3 months (0 vs. 9.9 ml/min/1.73 m(2), p = 0.032) when compared with the total-clamping RPN group. There were no significant differences in surgical margin and complication rates.
  
  
  CONCLUSIONS
  Selective-clamp confers improved renal functional outcomes in comparison to total-clamping RPN, with acceptable complications and oncological outcomes even in large and complex tumors.
authors.affiliation: Department of Urology, Chuncheon Sacred Hospital, Hallym Medical College, Chuncheon, South Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Shin
authors.forename: Sey Kiat
authors.initials: SK
authors.lastname: Lim
authors.forename: Christos
authors.initials: C
authors.lastname: Komninos
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Hong
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Jung
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D016022:Case-Control Studies; D003250:Constriction; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000379:methods*