Effect of multiple renal artery clamping on postoperative renal function in robot-assisted partial nephrectomy: A propensity-matched study

Objective To evaluate the effect of clamping multiple renal arteries on postoperative renal function in patients undergoing robot-assisted partial nephrectomy (RAPN). Methods A retrospective review of 694 patients who underwent RAPN for renal tumors between March 2016 and June 2023 was conducted. The patients were categorized into single and multiple clamp cohorts. Baseline differences were minimized using 1:1 propensity score matching. Renal function was evaluated using estimated glomerular filtration rate (eGFR) at 7 days and 1, 3, and 12 months postoperatively. Additionally, acute kidney injury (AKI), chronic kidney disease (CKD) progression, and dialysis requirements were evaluated. Statistical significance was defined as p < 0.05. Results After matching, 26 patients were included in each group. There were no significant differences in perioperative outcomes, including warm ischemia time, trifecta achievement, and surgical margin status. Despite a longer operative time in the multiple clamp group, no adverse effects on renal function were observed. There were no significant group differences in the eGFR at any time point or in the rates of AKI, CKD progression, or dialysis requirement. Conclusion Clamping of multiple renal arteries during RAPN did not appear to negatively affect short- or long-term postoperative renal function. Multiple clamping may be an acceptable technique for achieving a bloodless surgical field when necessary.