Robot-assisted laparoscopic partial nephrectomy using the selective clamping approach

Introduction and Objectives: To demonstrate the technique of robot-assisted laparoscopic partial nephrectomy (RAPN) using the selective clamping approach. Materials and Methods: A 56-year-old man presented with a 1.9 cm middle pole anterior right renal mass. Imaging studies demonstrated it to be likely a renal cell carcinoma. Transperitoneal RAPN was performed with intraoperative identification of an arterial branch supplying the region containing the renal tumour. Selective clamping of the polar branch was achieved, resulting in zero global renal ischaemia during the procedure. Results: Operative time was 2.5 hours with estimated blood loss 30 mL. Patient made an uneventful recovery and was discharged on postoperative day four. Pathology confirmed pT1aG2 clear cell carcinoma with clear margins. Conclusion: The selective clamping approach is an optimal strategy during RAPN and should be adopted if possible, to avoid global renal ischaemia. Meticulous dissection of the hilar vessels is essential to identify arterial branches for selective clamping.