University of Hertfordshire

From the same journal

By the same authors

  • Thomas Stonier
  • Bhavan Prasad Rai
  • Mariele Trimboli
  • Ahmed Abroaf
  • Amit Patel
  • S. Gowrie-Mohan
  • Venkat Prasad
  • Nikhil Vasdev
  • Jim Adshead
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Original languageEnglish
Pages (from-to)389-398
Number of pages10
JournalJournal of robotic surgery
Early online date10 Aug 2017
Publication statusPublished - 1 Dec 2017


To evaluate if early unclamping (EUC) of the renal pedicle compromises perioperative outcomes in minimally invasive partial nephrectomy (PN). The cohort study includes all robot-assisted PN performed between September 2012 and September 2015 by a single surgeon at the Lister Hospital, Stevenage, UK. The systematic review and meta-analysis was performed according to the PRISMA guidelines identifying studies comparing EUC and standard unclamping (SUC) in either laparoscopic or robot-assisted PN. The Lister cohort prospectively reported 84 cases of robot-assisted PN (SUC = 22, EUC = 62) with a mean age of 58 years (SD = 11). The operative time (OT), estimated blood loss (EBL) and warm ischaemia time (WIT) were 186.5 min (SD = 33.8), 125.5 mls (SD = 188.91) and 16.7 min (SD = 5.6), respectively. The data from the Lister cohort were included in the meta-analysis. The systematic review identified four studies, encompassing 666 cases (313 SUC, 353 EUC), for inclusion in the final analysis. There was a statistically significant difference in WIT in favour of the EUC group [−10.59 min (95% CI −16.58, −4.60)]. Specifically, the reduction in WIT was more pronounced in laparoscopic PN (−15.43 min (95% CI −19.05, −11.81)), when compared with the robotic PN [−5.60 min (95% CI −5.70, −5.50)]. There was no statistical difference in OT [−3.97 min (95% CI −14.22, 6.28)]. EBL was found to be increased in the EUC group [71.39 ml (95% CI −0.78, 143.56)]. There was no statistically significant difference in transfusion rates or complications between the two groups. The EUC technique for robot-assisted PN appears to offer a safe limited period of WIT without compromising perioperative outcomes and morbidity.


© Springer-Verlag London Ltd. 2017

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