Robotic partial nephrectomy without renal hilar occlusion


Jihad Kaouk, The Cleveland Clinic Foundation – Glickman Urological Institute, Laparoscopic/Minimally Invasive Surgery, 9500 Euclid Avenue/A100, Cleveland, OH, USA.


Study Type – Therapy (case series)
Level of Evidence 4


To evaluate operative outcomes among patients undergoing robotic partial nephrectomy (RPN) without renal hilar clamping.


This was a prospective observational study of patients undergoing RPN under perfused conditions (pRPN). Patients with solitary, radiographically enhancing renal cortical lesions gave consent for pRPN. Salient demographic data, including age, body mass index (BMI) and preoperative tumour size were obtained. Operative data, including mean operative time, estimated blood loss (EBL), and the presence of any complications, were collected. Renal function was evaluated before and after RPN. Remote adverse events were noted. The pRPN group was then retrospectively compared to a contemporary group of patients who had RPN with renal hilar occlusion. Endpoints for comparison included operative time, warm ischaemia time, EBL, length of hospitalization, and the rate of adverse events.


Between February 2008 and December 2008, eight had underwent pRPN; the mean age was 59.3 years, mean BMI 28.7 kg/m2, mean operative time 167 min, mean EBL 569 mL and mean hospitalization 3.75 days. Pathology showed renal cell carcinoma in five patients and oncocytoma in three; the mean tumour size was 2.4 cm. Final pathological margins were negative in all patients. Adverse events included one transfusion and one deep venous thrombosis. When compared to the contemporary group who had RPN with hilar clamping, the operative time was shorter (P = 0.035) and EBL greater (P = 0.018) in the pRPN group. There was no significant difference between the groups in transfusion rate, and no significant difference in renal function before and after surgery either group.


For selected small renal cortical masses, RPN is safe without renal hilar occlusion. The EBL was higher during pRPN but with no significant difference in the rate of transfusion.