title: Impact of robotic partial nephrectomy with and without ischemia on renal functions: experience in 34 cases.
abstract: OBJECTIVE
  In this study we aimed to compare renal functions in patients who underwent robotic partial nephrectomy (RPN) with on-clamp and zero- ischemia techniques.
  
  
  METHODS
  Between 2009 and 2015, 12 off-clamp and 22 on-clamp RPN procedures were performed on a total of 34 patients in two centers. The main outcome parameters examined were serum creatinine, and estimated glomerular filtration rate (eGFR) during preoperative, immediate postoperative periods, and at postoperative 3rdmonths.
  
  
  RESULTS
  There were no statistically significant differences between on-clamp and zero- ischemia groups regarding age, ASA score, BMI, PADUA and R.E.N.A.L. nephrometry scores, operation time and tumor size (p>0.05). Significant differences were found in the duration of hospital stay (3.8±0.9 days vs. 3.0±0.9 days) and amount of blood loss (85.9±49.6 mL vs. 183.3±176.2 mL) between the on-clamp and zero-ischemia groups (p<0.05). Statistically significant differences were found between preoperative and immediate post-operative periods, in terms of eGFR and serum creatinine levels in both groups. Moreover, statistically significant differences were found between preoperative and postoperative 3rdmonth periods, in the on-clamp group in terms of eGFR and serum creatinine levels. In the zero-ischemia group, the decrease in eGFR and serum creatinine levels at postoperative 3rdmonth relative to the preoperative period was not statistically significant.
  
  
  CONCLUSIONS
  Off-clamp RPN technique is superior, in short-term outcomes involving renal functions, compared to on clamp approach. However, long- term data regarding the renal functions should be evaluated to arrive at a definitive decision.
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Ener
authors.affiliation: Department of Urology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Altınova
authors.affiliation: Department of Urology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Atmaca
authors.affiliation: Department of Urology, Memorial Şişli Hospital, İstanbul, Turkey.
authors.forename: Erdal
authors.initials: E
authors.lastname: Alkan
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Erem
authors.initials: E
authors.lastname: Asil
authors.affiliation: Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Muhammet Fuat
authors.initials: MF
authors.lastname: Özcan
authors.affiliation: Department of Urology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Akbulut
authors.affiliation: Department of Urology, Memorial Şişli Hospital, İstanbul, Turkey.
authors.forename: Mevlana Derya
authors.initials: MD
authors.lastname: Balbay
keywords: Partial nephrectomy; kidney function; renal cell carcinoma; robotic surgery