Clampless and sutureless technique for complex robot assisted partial nephrectomy

• Clampless and sutureless robot-assisted partial nephrectomy are safe and effective techniques for nephron sparing surgery, independently by lesion size and location. • Clampless and sutureless techniques can lead to a better renal function preservation • Patients with multiple masses can benefit from these techniques Robot-assisted partial nephrectomy (RAPN) is currently the gold standard approach for the treatment of renal masses (T1-2N0M0). Many techniques have been developed to perform this procedure maximizing oncological and functional outcomes. In this setting, the clampless approach (enucleation without clamping the renal artery or its branches) together with the sutureless technique are considered to reduce the impact of ischemia on renal parenchyma and thus the impairment of renal function. To demonstrate the feasibility and safety of performing clampless and sutureless RAPN in several clinical scenarios of increasing complexity. Three RAPN cases, all done with clampless and sutureless techniques by a single experienced surgeon are considered. The first case was a two centimeters upper polar mass of the right kidney, with a RENAL score of 4. The second was a hilar mass of three centimeters of the right kidney with a RENAL score of 9. In the last case the technique was applied in a patient with Von Hippel Lindau syndrome and eight masses in the right kidney. In all the procedures ischemia time was zero. Mean blood loss was 300 (50-650) milliliters, and the mean operative time was 125 minutes (80-205). All the patients were discharged on the second post operative day. Mean value of post operative serum creatinine was 0,9mg/dl. No peri- and post-operative complications were recorded. All three cases were R0 at final pathology. Clampless and sutureless RAPN has proven to be a safe and effective approach to reduce the loss of renal function in nephron sparing surgery, without compromising surgical and oncological outcomes.