Category: Laparoscopic/ Robotic: Other
Introduction & Objective : Early unclamping (EU) during robot assisted partial nephrectomy (RAPN) is performed to decrease warm ischemia time (WIT). We have found that unclamping prior to completing the renorrhaphy also helps identify individual arterial bleeders. Therefore, we hypothesized that EU would reduce the rate of hemorrhagic complications and pseudoaneurysm formation after RAPN.
A multi-institutional database of patients who underwent RAPN from three surgeons was used to identify 668 patients with cT1 tumors and data on whether EU was performed. Surgeons adopted EU at different time points. EU and non-EU cases were propensity score matched and compared for each surgeon. Perioperative outcomes were compared including, WIT, estimated blood loss (EBL), complications (including bleeding and pseudo-aneurysm), and post-operative acute kidney injury (AKI) at discharge (>25% reduction in eGFR).
Results : For all three surgeons, EU was associated with shorter WIT (Δ= -3 minutes; Δ= -4 minutes, Δ= -4.5 minutes; p<=.001). Operative time was reduced for only one surgeon (Δ= -31 minutes, p<.001, Δ= -6 minutes, p=.742; Δ= -14 minutes, p=.425). There were no statistically significant differences in EBL (p=.291, p=.056, p=.425), incidence of all post-operative complications (lowest p=0.335), Clavien 3+ complications (lowest p=.551), bleeding (lowest p=.621) or pseudo-aneurysms formation (p=0.99). There was no statistically significant difference in AKI at discharge (lowest p=0.56).
Conclusions : EU is associated with shorter WITs during RAPN. There was a low incidence of hemorrhagic complications in both groups; therefore, we were unable to detect a significant difference in the incidences of these complications. However, no patients in the EU group developed a pseudoaneurysm, suggesting that it may be an affective technique to prevent pseudoaneurysm formation.
Zeynep Gul– Resident, Icahn School of Medicine at Mount Sinai, New York, New York
Marc Lubin– Fellow, Icahn School of Medicine at Mount Sinai, New York, New York
David Paulucci– Fellow, Icahn School of Medicine at Mount Sinai, New York, New York
Ronney Abaza– Director - Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio
Daniel Eun– Professor, Temple University, Philadelphia, Pennsylvania
Ketan Badani– Professor of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
Director - Robotic Surgery
OhioHealth Dublin Methodist Hospital