Sutureless off-clamp robot-assisted partial nephrectomy: a single-surgeon case series with insights into technique and complications

Aim: Previous literature has evaluated the feasibility and safety of robot-assisted partial nephrectomy (RAPN) performed entirely sutureless and off-clamp. The aim of the present study was to report a series of consecutive, unselected patients with renal masses of intermediate complexity who underwent sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN) by a single surgeon, focusing on surgical strategies, technique, and safety. Methods: A retrospective analysis was conducted on 29 patients between January 2022 and September 2024. Preoperative clinical characteristics, intraoperative data, and postoperative outcomes were examined, with particular attention to adverse events classified according to the Clavien-Dindo system. Additionally, hemoglobin, serum creatinine, and estimated glomerular filtration rate (eGFR) were analyzed at discharge and at three months postoperatively. Results: The median patient age was 60 years. All tumors were classified as T1a or T1b according to the tumor, node, metastasis (TNM) system. The median tumor diameter was 30 mm (range: 28-45), and the median PADUA score was 8 (range: 7-8). The median operative time (OT) was 135 min (range: 110/160), and the median estimated blood loss (EBL) was 100 mL (range: 50-100). Serum creatinine and eGFR at discharge and three months postoperatively showed no statistically significant changes (P > 0.05). Three patients (10%) experienced Clavien-Dindo ≥ 3 complications: two developed urine leakage requiring ureteral stent placement, and one experienced postoperative bleeding requiring blood transfusions. Conclusion: Although limited by a small sample size and the absence of a control group, and with urinary fistula as a potential limitation of the technique, sl-oc RAPN appears effective for treating intermediate-complexity renal tumors. It maintains oncological outcomes, minimizes complications, and preserves renal function.