Robot-assisted partial nephrectomy using the selective clamping approach

Abstract

Introduction and objectives: To demonstrate the steps of robot-assisted partial nephrectomy (RAPN) using the selective clampingapproach.Materials and methods: A 56-year-old man presented with a 1.9 cmmiddle pole anterior right renal mass. Imaging studies demonstrated itto be likely renal cell carcinoma without metastases. TransperitonealRAPN was performed with intraoperative identification of an arterialbranch supplying the region containing the renal tumor. Selectiveclamping of the polar branch was achieved, resulting in zero globalrenal ischemia during the procedure.Results: Operative time was 2.5 h with estimated blood loss 30 mL.Patient made an uneventful recovery and was discharged on post-operative day four. Pathology confirmed pT1aG2 clear cell carcinoma with clear margins. Conclusion: The selective clamping approach is an optimal strategyduring RAPN and should be adopted if possible, to avoid global renalischemia. Meticulous dissection of the hilar vessels is essential toidentify arterial branches for selective clamping.