Renal functional and perioperative outcomes of off-clamp versus clamped robot-assisted partial nephrectomy: Matched cohort study, "Beyond the Abstract," by Sherb Figenshau, MD

BERKELEY, CA (UroToday.com) - Frankly, I was a little surprised by the results of this study. I was expecting to see no difference in the postoperative renal function between the two groups. The study is small and retrospective, but the results did show better preservation of postoperative renal function in the off-clamp group. This difference was only noted in the eGFR and not noted in any of the clinical parameters, so any benefit remains unclear.

The technique for off-clamp partial nephrectomy is quite different than the on-clamp technique. The off-clamp technique is slow and meticulous, maintaining stringent hemostasis and careful dissection to create an optimum plane of dissection. On-clamp techniques are performed quickly to minimize the warm ischemia time for the kidney. It is not clear if either technique is better, however, on-clamp techniques are performed much more commonly. Off-clamp techniques are more attractive in patients that have compromised renal function or have solitary kidneys.

We have recently started a study at Washington University School of Medicine prospectively randomizing consecutive patients undergoing minimally invasive partial nephrectomy to on-clamp or off-clamp in an effort to answer whether there is any benefit to either technique with regard to preservation of renal function. We hope to have the enrollment for the study completed in about one year.

Written by:
Sherb Figenshau, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Taylor Family and Ralph V. Clayman, MD Chair in Minimally Invasive Urology
Division of Urology
Washington University School of Medicine
St. Louis, MO USA

Renal functional and perioperative outcomes of off-clamp versus clamped robot-assisted partial nephrectomy: Matched cohort study - Abstract

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