Bonifazi, M.

Campi, R.

Carini, Marco

Chini, T.

Gacci, M.

Mari, A.

Masieri, Lorenzo

Minervini, Andrea

Salvi, Matteo

Serni, Sergio

Sessa, F.

Siena, Giampaolo

Tuccio, Agostino

Vignolini, Graziano

English

Florence Research

643 Clamp vs clampless endoscopic robot-assisted simple enucleation (ERASE) for the treatmentof clinical T1 renal masses: Analysis of surgical and functional outcomes from a matched-paired comparison Eur Urol Suppl 2016;15(3);e643          Print!Mari A., Minervini A., Sessa F., Campi R., Bonifazi M., Chini T., Salvi M., Siena G., Tuccio A., Masieri L., Vignolini G., Gacci M., Serni S.,Carini M.Careggi University Hospital, Dept. of Urology, Florence, ItalyINTRODUCTION & OBJECTIVES: The potential negative impact of ischemia on renal function (RF) led to an increasing interest to avoidrenal clamping. The aim of the study was to compare the perioperative and functional outcomes of patients who underwent clamped andclampless ERASE in a high-volume centre.MATERIAL & METHODS: A matched-pair comparison of 120 clamp vs. 120 clampless over 350 patients treated with ERASE wasperformed matching for side, polar tumor location, clinical size score, urinary collecting system and renal sinus dislocation. Perioperativeand functional outcomes were compared between groups. Renal function was calculated using biochemical markers (Sr Creatinine, eGFRusing MDRD and chronic kidney disease (CKD) stage according to eGFR).RESULTS: The groups were comparable for demographic, clinical and nephrometry tumor features. Clinical T1a tumors were 107 (89.2%)and 108 (90%), median PADUA score was 7.0 (6.0-7.5) and 7.0 (6.0-8.0) in the clamp and clampless group, respectively. PreoperativeCKD stage 1, 2, 3A, 3B and 4 were identified in 50.0%, 39.2%, 5.0%, 3.3%, 2.5% of clamp ERASE vs. in 46.7%, 44.2%, 5.0%, 2.5, 1.7% ofclampless ERASE. Warm ischemia time was > 20 and >25 minutes in 11.6% and 5.0% of clamp cases. Median intraoperative time wassignificantly higher in clamp cases (150 vs. 120; p<0.0001). No intraoperative complications were registered in both groups. Overall,Clavien 2 and 3 surgical complications were 2.5%, 0.8% and 1.7% vs. 3.3%, 2.5% and 0.8% clamp and clampless ERASEs. Surgicalmargins were registered in 1.7% of each group. Median delta preoperative- 1st postoperative day (POD) and preoperative – 30th PODeGFR was 5.5 (0-15.6) and 8.9 (2.5-19.7) in clamp ERASE vs 1.1 (0-8.5) and 3.2 (0-8.2) clampless ERASE (p=0.01 and p<0.0001,respectively). Preoperative- 30th POD Delta CKD stage was 0 in 82.5% and 91.7%, +1 in 15.0% and 8.3%, +2 2.5% and 0% of clamp andclampless ERASEs, respectively (p=0.01).CONCLUSIONS: In our experience, clampless ERASE is a feasible and safe surgical technique with comparable postoperative outcomesand providing a significantly lower rate of early CKD development compared to clamp procedures.

Clamp vs clampless endoscopic robot-assisted simple enucleation (ERASE) for the treatment
of clinical T1 renal masses: Analysis of surgical and functional outcomes from a matchedpaired
comparison

https://flore.unifi.it/bitstream/2158/1056735/1/643-Clamp-vs-clampless-endoscopic-robot-assisted-simple-enucleation-ERASE-for-the-treatment-of-clinical-T1-renal-masses-Analysis-of-surgical-and-funct%20-%20Copia.pdf

Clamp vs clampless endoscopic robot-assisted simple enucleation (ERASE) for the treatment

of clinical T1 renal masses: Analysis of surgical and functional outcomes from a matchedpaired

comparison

Clamp vs clampless endoscopic robot-assisted simple enucleation (ERASE) for the treatment of clinical T1 renal masses: Analysis of surgical and functional outcomes from a matchedpaired comparison

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