Robotic Partial Nephrectomy Without Renal Ischemia REPLY

OBJECTIVE To evaluate our outcomes of robotic partial nephrectomy (RPN) without renal artery clamping (off-clamp), in order to avoid ischemic renal injury, using cold-scissor tumor excision and sutured reconstruction without ablation or other regional hypoperfusion. MATERIALS AND METHODS Between September 2009 and October 2010, patients who underwent off-clamp RPN for >= 1 tumors were reviewed from a prospective database. All procedures were performed by a single surgeon experienced in RPN. Indications included solitary kidney, multiple tumors in the same kidney, or electively when they it was possible. RESULTS Twenty-eight off-clamp RPNs were performed in 22 patients. Mean age and body mass index were 55 years (range 24-73) and 31 kg/m(2). Mean operative time was 183 minutes with mean blood loss of 274 mL. One patient required transfusion and was the only patient with Clavien grade II or higher complications (4.5%). Mean +/- SD off-clamp tumor size on final pathology was 2.1 +/- 1.1 cm (range 0.8-4.9) with mean RENAL nephrometry score of 6.25 (4a-9ph). For patients with additional tumors undergoing RPN with clamping, mean warm ischemia time was 12.1 minutes (range 7-19.3) for tumors of 4.6-10.5 cm. Twenty patients (91%) were discharged on postoperative day 1. All had negative margins. Mean preoperative, immediate postoperative, and 6-month postoperative estimated glomerular filtration rate were 89.8, 77.5, and 86.5 mL/min, respectively. CONCLUSION For selected patients and tumors, RPN without ischemia is feasible without ablation, energy resection, or regional hypoperfusion. Further experience is necessary to determine which patients are ideally suited. UROLOGY 79: 1296-1302, 2012. (C) 2012 Elsevier Inc.