Partial nephrectomy is the preferred treatment for small renal tumors, with robotic-assisted partial nephrectomy (RAPN) being the most common approach. Studies show RAPN offers shorter warm ischemia times and similar positive margin rates compared to laparoscopic partial nephrectomy. Off-clamp RAPN has comparable perioperative complications to on-clamp RAPN, but may better preserve renal function and reduce positive margin rates. This study aimed to analyze the perioperative outcomes of off-clamp versus on-clamp RAPN.

We recruited patients who underwent RAPN for renal tumors at our institute between September 2020 and July 2024. Patients with a retroperitoneal approach or those who had resection of more than one tumor were excluded. A total of 23 patients were included. We compared patient characteristics, operative outcomes, postoperative recovery, and complications between groups. Continuous variables were assessed for normality using the Student's t-test, and categorical variables were analyzed with the chi-squared test. Statistical analyses were performed using IBM SPSS software, with p < 0.05 considered statistically significant.

There were no significant differences in patient characteristics between the groups, except for hypertension and preoperative creatinine levels (Table 1). Both off-clamp and on-clamp RAPN had similar operative times, blood loss, and transfusion rates (Table 2). Off-clamp RAPN showed a trend toward less creatinine elevation, while on-clamp RAPN was linked to faster flatulence notification and a shorter ICU stay. No significant differences were found in positive margin rates, complications, or changes in creatinine levels and eGFR during follow-up.

Off-clamp RAPN showed a trend toward less elevation in creatinine levels on postoperative day 1 and better preservation of renal function during the 3-month follow-up. However, these trends did not reach statistical significance, and further research is needed to confirm these findings.