Anderson Barrett G, Potretzke Aaron M, Du Kefu, Vetter Joel M, Bergeron Karla, Paradis Alethea G, Figenshau R Sherburne
Department of Urology, Detroit Medical Center, Detroit, MI.
Department of Urology, Mayo Clinic, Rochester, MN.
Urology. 2019 Apr;126:102-109. doi: 10.1016/j.urology.2018.11.053. Epub 2019 Jan 16.
To determine whether performing robot-assisted partial nephrectomy without warm ischemia "off-clamp" results in favorable postoperative renal functional outcomes compared with the on-clamp method.
We conducted a prospective trial of 80 patients who underwent robot-assisted partial nephrectomy. They were randomized in a 1:1 ratio to undergo the procedure with renal artery clamping or without clamping. The groups were compared across demographics, operative information, perioperative outcomes, and postoperative renal function. We assessed renal function by estimated glomerular filtration rate and renal scintigraphy both preoperatively and at 3 months postoperatively.
Patients in the on-clamp and off-clamp groups were similar in age, gender, body mass index, comorbidities, clinical tumor size, nephrometry score, and laterality. Off-clamp procedures were lengthier at an average 178.0 minutes vs 156.0 minutes for on-clamp (P = .011). Estimated blood loss, rates of pelvicalyceal repair, postoperative complications, and positive margins were not different. At a median 3-month follow-up, no significant differences were seen in change in postoperative estimated glomerular filtration rate or percent split renal function between both groups.
In this prospective study, off-clamp robot-assisted partial nephrectomy resulted in similar perioperative outcomes compared with the on-clamp technique. No benefit was demonstrated in the preservation of renal function. Urologists may safely employ either an on-clamp or off-clamp strategy depending on surgeon preference and patient-specific factors including baseline renal insufficiency, multiple masses, or solitary kidney.
确定与肾动脉阻断法相比，不进行热缺血“无阻断”机器人辅助部分肾切除术是否能带来良好的术后肾功能结果。
我们对80例行机器人辅助部分肾切除术的患者进行了一项前瞻性试验。他们以1:1的比例随机分组，分别接受肾动脉阻断或不阻断的手术。对两组患者的人口统计学特征、手术信息、围手术期结果和术后肾功能进行比较。我们在术前和术后3个月通过估计肾小球滤过率和肾闪烁扫描评估肾功能。
肾动脉阻断组和无阻断组患者在年龄、性别、体重指数、合并症、临床肿瘤大小、肾计量评分和患侧等方面相似。无阻断手术时间更长，平均为178.0分钟，而肾动脉阻断手术平均为156.0分钟（P = 0.011）。估计失血量、肾盂输尿管修复率、术后并发症和切缘阳性率无差异。在中位3个月的随访中，两组术后估计肾小球滤过率的变化或分肾功能百分比均无显著差异。
在这项前瞻性研究中，无阻断机器人辅助部分肾切除术与肾动脉阻断技术相比，围手术期结果相似。在肾功能保护方面未显示出益处。泌尿外科医生可根据外科医生的偏好和患者的具体因素，包括基线肾功能不全、多发肿块或孤立肾，安全地采用肾动脉阻断或无阻断策略。
