Off-Clamp Robot-Assisted Partial Nephrectomy: Is There Something More to Achieve Optimal Trifecta Outcomes?

Objectives: To report trifecta outcomes of our "off-clamp" partial nephrectomy (PN) patients operated without main renal artery and/or any selective/superselective clamping. Materials and Methods: Between April 2008 and March 2020, 52 patients received "off-clamp" robot-assisted partial nephrectomy. Postoperative sixth month estimated glomerular filtration rate (eGFR) and eGFR decrease were considered for renal function evaluation. Patients with negative surgical margins, Results: Mean age and body mass index of the patients were 57.51 +/- 12.99 years and 27.23 +/- 4.35 kg/m(2), respectively. Mean preoperative hematocrit, serum creatinine, and eGFR were 42.01 +/- 3.86%, 0.92 +/- 0.28 mg/dL, and 85.26 +/- 21.27 mL/min/1.73 m(2), respectively. Mean tumor size was 30.32 +/- 13.64 mm. Mean PADUA and RENAL scores were 7.63 +/- 1.46 and 6.21 +/- 1.63, respectively. One patient had focal surgical margin positivity. Mean console time and estimated blood loss was 82.11 +/- 38.51 minutes and 280.76 +/- 278.98 mL, respectively. Complications were observed in two (4%) patients (one Clavien I, one Clavien IIIB). At postoperative sixth month, serum creatinine and eGFR were 0.95 +/- 0.32 mg/dL and 83.65 +/- 22.44 mL/min/1.73 m(2), respectively. Eventually seven patients had >= 15% postoperative eGFR decrease, one patient had grade >= 2 complication and one patient had positive surgical margin. Forty-three (83%) patients fulfilled trifecta outcomes. Conclusion: Off-clamp PN is important for optimal renal function preservation. Patient selection and additional operative measures along with experience in robotic procedure can contribute achievement of optimal trifecta outcomes.