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Introduction:
One method to decrease ischemia time during robotic partial nephrectomy (RPN) is through removal of the hilar clamp immediately after suturing the tumor bed, and performing the remainder of the renorrhaphy “off clamp”: the early unclamping technique (EU). This approach has the potential for increased blood loss however, it may offer improved visualization and suture control of arterial bleeders after clamp removal. Our study evaluates whether this technique is safe and reproducible by a group of international academic surgeons.
Materials & Methods:
680 patients at 7 institutions underwent EU RPN between 2009-2014. This dataset represents the initial EU RPNs performed by this group. Our prospective database was queried to evaluate surgical results.
Results:
None of the 680 patients required re clamping after EU. The median warm ischemia time was 14.4 min (range 2-50 mins), median RENAL score was 7 (range 4-12), median tumor size was 3.1 cm (range 0.5-10.5 cm), median operative time was 173 mins (range 60-581 mins and median blood loss was 249 mls (range 5-1800 mls). 75/680 patients required blood transfusion (16% in first half of our experience and 6% in the second half). Overall complication rate was 23% with 6% Clavien grade III or more. In 93% of cases, WIT was ≤ 25 minutes. Overall positive margin rate was 5%.
Conclusions:
Early unclamping during RPN is a safe and reproducible technique that may allow for decreased WIT without excessive overall morbidity. As with all RPN techniques, increased experience and surgical volume will improve results.