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Robot-Assisted Partial Nephrectomy: Early Unclamping Technique
Ignacio F. San Francisco, M.D.1, Michael C. Sweeney, M.D.2, Andrew A. Wagner, M.D.2
1Pontificia Universidad Católica de Chile and Beth Israel Deaconess Medical Center, Santiago, Chile, 2Beth Israel Deaconess Medical Center, Boston, MA

BACKGROUND: Robot-assisted partial nephrectomy (RAPN) has emerged as a minimally invasive surgical technique for small renal tumors. The warm ischemia time during laparoscopic partial nephrectomy has been reduced using an early unclamping technique in experienced hands. However, to our knowledge, there are no existing publications regarding early unclamping technique in RAPN. We present our series of RAPN using early unclamping technique.
METHODS: From August 2009 to April 2010 a total of 12 consecutive RAPN were performed by single surgeon. Of the 12 RAPN, the last 8 have been performed using early unclamping technique. Clinical and pathological data were obtained from our prospectively maintained kidney surgery database at Beth Israel Deaconess Medical Center.RESULTS: Our early results after eight cases using early unclamping technique show a median age of 61 yo, 6 of the patients were males and 6 were left side tumors. The median BMI and tumor size were 29 and 2.5 cms respectively (1.4- 5.2). Most of the tumor were in the upper pole. The median operative time was 249 minutes (191- 315) with a clamp time of 16 minutes (14-28). The median estimated blood loss was 100 cc (50-500) and the length of stay was 2 days. The pathology showed that 2 of the tumors were benigns and 1 had positive margin. We did not have any intraoperative or postoperative complications.
CONCLUSIONS: RAPN using early unclampling technique is a safe and feasible option in experienced hands. However, requires a highly skilled bed side assistant. Early unclamping technique does not increase estimated blood loss in our series.


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