Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial
| Autor: | R. Sherburne Figenshau, Joel Vetter, Aaron M. Potretzke, Barrett G. Anderson, Kefu Du, Karla Bergeron, Alethea Paradis |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Renal function Kidney Function Tests Nephrectomy law.invention Constriction 03 medical and health sciences Renal Artery 0302 clinical medicine Robotic Surgical Procedures Randomized controlled trial law medicine.artery medicine Humans Prospective Studies Renal artery Prospective cohort study business.industry Recovery of Function Perioperative Middle Aged Surgery Treatment Outcome 030220 oncology & carcinogenesis Female business Body mass index |
| Zdroj: | Urology. 126:102-109 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2018.11.053 |
| Popis: | Objective To determine whether performing robot-assisted partial nephrectomy without warm ischemia “off-clamp” results in favorable postoperative renal functional outcomes compared with the on-clamp method. Methods We conducted a prospective trial of 80 patients who underwent robot-assisted partial nephrectomy. They were randomized in a 1:1 ratio to undergo the procedure with renal artery clamping or without clamping. The groups were compared across demographics, operative information, perioperative outcomes, and postoperative renal function. We assessed renal function by estimated glomerular filtration rate and renal scintigraphy both preoperatively and at 3 months postoperatively. Results Patients in the on-clamp and off-clamp groups were similar in age, gender, body mass index, comorbidities, clinical tumor size, nephrometry score, and laterality. Off-clamp procedures were lengthier at an average 178.0 minutes vs 156.0 minutes for on-clamp (P = .011). Estimated blood loss, rates of pelvicalyceal repair, postoperative complications, and positive margins were not different. At a median 3-month follow-up, no significant differences were seen in change in postoperative estimated glomerular filtration rate or percent split renal function between both groups. Conclusion In this prospective study, off-clamp robot-assisted partial nephrectomy resulted in similar perioperative outcomes compared with the on-clamp technique. No benefit was demonstrated in the preservation of renal function. Urologists may safely employ either an on-clamp or off-clamp strategy depending on surgeon preference and patient-specific factors including baseline renal insufficiency, multiple masses, or solitary kidney. |
| Databáze: | OpenAIRE |
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