Off-clamp vs On-clamp RAPN: A Systematic Review and Meta-analysis

What is it about?

This meta-analysis compares the intra- and postoperative outcomes of off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN). The study found no significant difference in estimated operative blood loss between the two approaches. However, off-clamp RAPN yielded better preservation of renal function and lower odds of positive surgical marges compared to on-clamp RAPN. The study also found no significant differences in total operative time, rates of postoperative complications, or major complications between both approaches. The study concludes that off-clamp RAPN is a feasible alternative to on-clamp RAPN for selected renal masses, with better preservation of renal function and possibly lower margin-positive rates.

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Why is it important?

The study is important because it compares the intra- and postoperative outcomes of off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN). The results provide valuable insights into the effectiveness of these two approaches for renal masses and their impact on renal function preservation, postoperative complications, and margin positivity. This information can help surgeons and patients make informed decisions about the best approach for individual cases. Key Takeaways: 1. Off-clamp RAPN is a feasible alternative to on-clamp RAPN for selected renal masses, offering better preservation of renal function and the possibility of lower margin-positive rates. 2. There were no significant differences in blood loss or need for transfusion between both approaches. 3. Total operative time and rates of postoperative complications were comparable between on-clamp and off-clamp RAPN. 4. The choice of RAPN technique (enucleation vs enucleo-resection vs resection) may impact positive resection margins, and this should be considered when choosing the approach. 5. The study highlights that patients with complex renal masses, large tumours, or solitary kidneys may benefit from an off-clamp approach, as these factors are associated with prolonged clamping times if an on-clamp approach is chosen.