title: Off-clamp robotic partial nephrectomy: Technique and outcome.
abstract: BACKGROUND
  Robotic partial nephrectomy (RPN) is a technically challenging procedure. Advanced skills are needed to accomplish tumor resection, hemostasis, and renorrhaphy within short ischemia time in RPN. Off-clamp RPN with zero ischemia may decrease the risk of ischemic reperfusion injury to the kidney. However, the off-clamp technique has been associated with an increased risk of blood loss. The purpose of this study was to evaluate the outcome of our modified off-clamp technique utilized in certain RPN cases.
  
  
  METHODS
  A total of 81 patients underwent RPN between September 2009 and July 2013 for renal masses. We studied a subgroup of patients who underwent off-clamp RPN with zero ischemia time. The off-clamp technique was utilized for exophytic, nonhilar tumors that have a base of 2 cm or less. We developed a novel technique to avoid ischemia reperfusion renal injury while minimizing blood loss in certain cases of RPN.
  
  
  RESULTS
  Of the 81 cases of RPN, we reviewed and adopted the off-clamp technique in 34 patients (41.98%). Utilizing off-clamp RPN resulted in an average blood loss of 96.29 ml and 1.56 days (range: 1-3 days) of hospital stay and minimal change in serum creatinine.
  
  
  CONCLUSIONS
  Off-clamp RPN is safe and feasible approach to excise certain kidney tumors. It carries the benefits of RPN and prevents ischemia reperfusion renal injury.
authors.affiliation: Department of Surgery, Division of Urology, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Abdulraouf Y
authors.initials: AY
authors.lastname: Lamoshi
authors.affiliation: Department of Surgery, Division of Urology, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Mohamad W
authors.initials: MW
authors.lastname: Salkini
keywords: Warm ischemia; nephron sparing; partial nephrectomy; robotic surgery
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