Laparoscopic/ Robotic: Other

Moderated Poster Session

MP16-12 - Off-clamp robotic assisted partial nephrectomy in patients with preexisting renal insufficiency or solitary kidneys

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 243

Introduction & Objective :

Performing Robotic-assisted partial nephrectomy (RAPN) "off-clamp" may avert renal functional loss associated with warm ischemia. In a previous randomized trial, we did not observe any difference in change in renal function in the general population. We retrospectively compared perioperative and renal functional outcomes in patients with baseline renal insufficiency and/or solitary kidneys who underwent RAPN either off-clamp or on-clamp.


Methods : We retrospectively reviewed a prospectively maintained database of patients who underwent RAPN at our institution from 2007 to 2017 with available renal function measurements at least 3 months postoperatively.  In patients who had chronic renal insufficiency (CRI) with preoperative estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or solitary kidney, those who underwent off-clamp RAPN were compared to on-clamp RAPN across patient characteristics, operative data, and renal functional outcomes. Renal function measurements closest to one year after surgery were used to minimize variability.


Results :

In the 76 patients with CRI, there was no difference in patient characteristics, operative variables, and postoperative complications between on- and off-clamp groups. Multivariate analysis showed a trend toward worse renal function loss for the on-clamp group compared to the off-clamp group by -10.1% (95% confidence interval -21.2%— 0.9%, p = 0.072). Of the 15 patients with solitary kidneys, off-clamp procedures resulted in less estimated blood loss (117.8 mL vs 916.7 mL, p = 0.026). Univariate analysis showed lessened renal function reduction for off-clamp RAPNs in this small cohort (-9.5% vs -30.7%, p = 0.036) (Table 1).


Conclusions :

Off-clamp RAPN appears to ameliorate renal function loss compared to on-clamp RAPN in patients with preexisting renal insufficiency and solitary kidneys.

Kefu Du

Fellow
Washington University in St. Louis

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    Barrett Anderson

    Clinical Assistant Professor
    Michigan State University / Detroit Medical Center

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      Aaron M. Potretzke

      Senior Associate Consultant
      Department of Urology, Mayo Clinic, Rochester, MN

      Aaron Mark Potretzke, MD is an assistant professor and senior associate consultant at the Mayo Clinic in Rochester, MN. He completed residency at the University of Wisconsin in Madison, WI and a two-year fellowship in Minimally Invasive Urologic Surgery and Endourology at Washington University in St. Louis, MO. His clinical interests include minimally invasive management of renal and upper tract urothelial cancer, as well as upper urinary tract obstructive disease and urolithiasis. His research focuses on renal and upper tract urothelial cancer.

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        Joel Vetter

        Statistician
        Washington University in St. Louis

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          Alethea Paradis

          Research manager
          Washington University in St. Louis

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            Robert Figenshau

            Professor
            Washington University in St. Louis

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