Impact of early unclamping technique on perioperative and postoperative outcomes in robot-assisted laparoscopic partial nephrectomy: a propensity score-matched analysis from a single center.

BACKGROUND: The clinical significance of early unclamping (EUC) in robot-assisted laparoscopic partial nephrectomy (RAPN) remains unclear. The aim of this study was to compare perioperative and postoperative outcomes between EUC and standard unclamping (SUC) in RAPN for patients with localized renal tumors. METHODS: We retrospectively analyzed 117 patients who underwent RAPN in our department between 2013 and 2023, with a minimum follow-up of 12 months. EUC was defined as unclamping after achieving primary hemostasis using inner sutures and/or soft coagulation, whereas SUC was performed after hemostasis and renorrhaphy. A 1:1 propensity score-matching analysis was conducted. Logistic regression was used to identify predictors of renal function preservation, defined as an eGFR decline of less than 10% at 12 months. RESULTS: After matching, 31 patients were included in each group. The EUC group had a significantly shorter warm ischemia time (WIT) (19 vs. 28 min; p < 0.001). Although estimated blood loss was higher in the EUC group (50 vs. 0 mL; p < 0.001), no significant difference was observed in postoperative hemoglobin decline. The EUC group showed significantly smaller eGFR declines at 6 months (-4.2% vs. -15%; p = 0.005) and 12 months (-5.3% vs. -14%; p < 0.001). Multivariable analysis revealed that EUC was an independent predictor of renal function preservation (odds ratio: 11.8; 95% confidence interval: 2.57-54.5; p = 0.002). CONCLUSIONS: Our study suggests that EUC significantly reduces WIT and contributes to better renal function at 6 and 12 months postoperatively. EUC appears to be a viable technique for preserving renal function without increasing complications.