title: Early vascular unclamping reduces warm ischaemia time in robot-assisted laparoscopic partial nephrectomy.
abstract: BACKGROUND
  The aim of this study was to assess the outcomes of early vascular release in robot-assisted laparoscopic partial nephrectomy (RAPN) to reduce warm ischaemia time (WIT) and minimise renal dysfunction. RAPN is increasingly utilised in the management of small renal masses. To this end it is imperative that WIT is kept to a minimum to maintain renal function.
  
  
  METHODS
  RAPN was performed via a four-arm robotic transperitoneal approach. The renal artery and vein were individually clamped with robotic vascular bulldog clamps to allow cold scissor excision of the tumour. The cut surface was then sutured with one or two running 3-0 V-Loc (TM) sutures, following which the vascular clamps were released. Specific bleeding vessels were then selectively oversewn and the collecting system repaired. Renorrhaphy was then completed using a running horizontal mattress 0-0 V-Loc (TM) suture.
  
  
  RESULTS
  A total of 16 patients underwent RAPN with a median WIT of 15 minutes (range: 8-25), operative time 230 minutes (range: 180-280) and blood loss of 100 mL (range: 50-1000). There were no transfusions, secondary haemorrhages or urine leaks. There was one focal positive margin in a central 5.5 cm pT3a renal cell carcinomas (RCC). Long-term estimated glomerular filtration rate (eGFR) was not significantly different to pre-operative values.
  
  
  CONCLUSIONS
  In this patient series, early vascular release effectively minimised WIT and maintained renal function without compromising perioperative safety.
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, 4006, Australia ; University of Queensland School of Medicine, Brisbane, Queensland, 4006, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lah
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, 4006, Australia ; University of Queensland School of Medicine, Brisbane, Queensland, 4006, Australia.
authors.forename: Devang
authors.initials: D
authors.lastname: Desai
authors.affiliation: The Wesley Hospital, Brisbane, Queensland, 4066, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Chabert
authors.affiliation: University of Queensland School of Medicine, Brisbane, Queensland, 4006, Australia ; The Wesley Research Institute, Brisbane, Queensland, 4066, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Gericke
authors.affiliation: Royal Brisbane and Women's Hospital, Brisbane, Queensland, 4006, Australia ; University of Queensland School of Medicine, Brisbane, Queensland, 4006, Australia ; The Wesley Hospital, Brisbane, Queensland, 4066, Australia.
authors.forename: Troy
authors.initials: T
authors.lastname: Gianduzzo
keywords: Partial nephrectomy; Renal Mass; Renal function; Robot-assisted laparoscopy