Purely off-clamp robotic partial nephrectomy
In this video we describe our surgical technique, reporting perioperative, 3-yr oncologic and functional outcomes of a single centre series of 308 patients treated with robotic off-clamp PN (OFF-RPN).
Data of all patients underwent OFF-RPN between 2010 and 2015 in a high-volume centre were collected.
Patients were placed in an extended flank position and a 5-port access with a side docking was performed. Hilar vessels were not clamped in any case; pure tumour enucleation or enucleoresection were the resection techniques used; renorraphy was omitted for small and exophytic masses and minimized with a “point specific haemostasis” for hilar tumours.
Perioperative complications, 3-yr oncologic and functional outcomes were reported. Univariable and multivariable analyses were performed to identify independent predictors of RF deterioration.
Out of 308 patients treated, 41 (13.3%) experienced perioperative complications, 2.9% of which were Clavien grade ≥3. Three-yr local recurrence free survival and cancer specific survival rates were 99.5% and 97.9%, respectively.
No patient with preoperative CKD-stage ≤3B developed severe RF deterioration (CKD-stage 4) at 1-yr follow-up.
Preoperative eGFR (p=0.005) was the only independent predictor of a new onset CKD-stage ≥3 in patients with preoperative CKD-stages 1 or 2.
OFF-RPN is a safe surgical approach in tertiary referral centres, with adequate oncological outcomes and negligible impact on RF.