Three-dimensional Perfusion-zone Models Allow More Selective Clamping During Robot-assisted Partial Nephrectomy: Brief Report on a Retrospective Analysis.

Selective clamping (SC) of the renal artery during robot-assisted partial nephrectomy (RAPN) may yield better preservation of renal function in comparison to main-artery clamping (MAC), especially in patients at higher risk of kidney injury. This retrospective study investigated whether the availability of three-dimensional (3D) renal perfusion models influences the choice between SC and MAC in RAPN. A total of 148 procedures for T1-2 renal tumors performed between January 2020 and June 2024 at a single referral center were analyzed. All surgeries involved either SC or MAC; off-clamp cases were excluded. In 74% of cases, a 3D perfusion-zone (3DPZ) model was available at the time of surgery. Surgeons always aimed to perform SC if deemed feasible. A strong association between the availability of a 3DPZ model and SC use was observed (χ2 p < 0.001). This result suggests that access to 3DPZ models may support a more selective approach to renal artery clamping when pursuing an SC strategy. While limited by its retrospective nature and potential selection bias, this study provides a rationale for further investigation of the benefits and clinical outcomes of 3DPZ model use during RAPN. This issue will be further investigated in the prospective multicenter PODRACING trial (NCT06536439). Patient summary: For patients undergoing robot-assisted surgery to remove a kidney tumor, a three-dimensional (3D) model of the kidney can show the surgeon which regions receive blood supply from which artery. We found that use of a 3D model helps in selecting which arteries to clamp around the tumor, leaving the healthy parts of the kidney with full blood supply during surgery. A clinical trial is now being carried out to confirm whether this technology can improve surgical outcomes.