Comparison Of Clinical Efficacy Between Off-clamp And On-clamp Of Renal Artery In Retroperitoneal Robot-assisted Laparoscopic Partial Nephrectomy

Objective:To investigate the feasibility and clinical outcome of off-clamp technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy.Methods:The clinical data of 40 patients with localized renal cancer who underwent retroperitoneal robot-assisted laparoscopic partial nephrectomy in First Affiliated Hospital of Nanchang University from April 2016 to October 2017 were retrospectively collected and analyzed.18 cases used off-clamped technique(off-clamped group),The remaining 22 cases were included in clamping group.Operative time,estimated blood loss,postoperative complications and postoperative GFR changes were compared between the two groups.Results:All cases were successfully performed robotically without conversion or transfusion.No positive surgical margin was noted in all cases.Postoperative complications were limited to Grade II according to Clavien-Dindo classification.No significant increase in operative time was observed in off-clamp group vs clamping group [(155.83±39.47)min vs(139.86±25.84)min,P=0.132],Ipsilateral GFR decline rate was significantly lower in oo-clamp group [(4.22±2.92)% vs(8.61±5.03)% in 3 months,P=0.002;(11.05±5.26)% vs(23.33±4.68)% in 12 months,P=0.000] which was associated with higher intraoperative blood loss [(193.33±67.56)ml vs(133.59±65.26)ml,P=0.007].No recurrence was noted during a follow-up of 3 to 18 months.Conclusion:Proper patient(T1a stage with superficial position,mostly exogenous,and a score of R.E.N.A.L less than or equal to 7 points)selection for off-clamping retroperitoneal robotic-assisted laparoscipic partial nephrectomy may eliminate warm ischemic renal injury without increasing overall operative time and risk of postoperative complication.An increase in intraoperative blood loss may be expected overall,the off-clamp technique can be implanted safely and feasibly in experienced hands.