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Clinical values of selective-clamp technique in robotic partial nephrectomy

Authors
 Tae Young Shin  ;  Sey Kiat Lim  ;  Christos Komninos  ;  Dong Wook Kim  ;  Woong Kyu Han  ;  Sung Jun Hong  ;  Byung Ha Jung  ;  Koon Ho Rha 
Citation
 WORLD JOURNAL OF UROLOGY, Vol.33(6) : 763-769, 2015 
Journal Title
WORLD JOURNAL OF UROLOGY
ISSN
 0724-4983 
Issue Date
2015
MeSH
Adult ; Aged ; Carcinoma, Renal Cell/surgery* ; Case-Control Studies ; Constriction ; Databases, Factual ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms/surgery* ; Male ; Middle Aged ; Nephrectomy/methods* ; Postoperative Complications/epidemiology* ; Renal Insufficiency, Chronic/epidemiology* ; Retrospective Studies ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Warm Ischemia/methods*
Keywords
Partial nephrectomy ; Renal cell carcinoma ; Warm ischemia time
Abstract
PURPOSE: In the era of robotic partial nephrectomy (RPN), several efforts on improved renal functional outcome have been reported. Selective-clamp is a novel technique that eliminates global ischemia, the clinical value of which needs to be demonstrated. The purpose of this study was to compare the postoperative functional outcomes of patients who underwent selective-clamp and total-clamping RPN.
PATIENTS AND METHODS: From February 2009 to October 2012, a database of 126 consecutive patients who underwent RPN was retrospectively analyzed, 117 patients met our inclusion criteria and were stratified into two groups, 20 patients underwent selective-clamp RPN, and 97 patients underwent total-clamping RPN. Post hoc power analysis was subsequently performed for calculation of sufficient sample size. Demographics/tumor characteristics, functional outcomes and complications were analyzed.
RESULTS: All selective-clamp RPN cases were successfully performed. Mean tumor size was 3.4 cm [standard deviation (SD): ±1.4], mean RENAL nephrometry score was 7.3 (SD: ±2.0), and no Clavien-Dindo III-V complications were recorded. Selective-clamp RPN group had a significantly lower percentage decrease in the postoperative estimated glomerular filtration rate at 1 week (1.8 vs. 20.8 ml/min/1.73 m(2), p = 0.001) and 3 months (0 vs. 9.9 ml/min/1.73 m(2), p = 0.032) when compared with the total-clamping RPN group. There were no significant differences in surgical margin and complication rates.
CONCLUSIONS: Selective-clamp confers improved renal functional outcomes in comparison to total-clamping RPN, with acceptable complications and oncological outcomes even in large and complex tumors.
Full Text
http://link.springer.com/article/10.1007%2Fs00345-014-1333-2
DOI
10.1007/s00345-014-1333-2
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/141227
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