Reply to Nikolaos Grivas and Henk G. van der Poel's Letter to the Editor re: Rui Farinha, Giuseppe Rosiello, Artur De Oliveira Paludo, et al. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2021.03.019

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

OBJECTIVE

To investigate the clinical safety and efficacy of a modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN).

METHODS

The clinical data of 38 patients with renal tumors who underwent the modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative-related indicators and postoperative renal function recovery were analyzed and compared between the two groups.

RESULTS

All patients (n = 116) finished the RAPN successfully, and none were transferred to radical or open surgery in either group. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time point in the modified early unclamping group was higher than that in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis.

CONCLUSION

The application of a modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys without increasing the volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.