Clampless or not? Evidence for robotic partial nephrectomy
Evidence and outcomes
In this ERUS 2026 lecture, Dr A. Franco reviews the evidence behind clampless and sutureless robotic partial nephrectomy, addressing the key questions of vascular clamping and renorrhaphy. Drawing on studies including the CLOCK and EMERALD trials, he examines the impact of different surgical strategies on safety, functional preservation and perioperative outcomes.
Key technical principles
For selected low- to intermediate-complexity renal tumours, sutureless off-clamp robotic partial nephrectomy can achieve outcomes comparable to conventional renorrhaphy in experienced hands. Accurate tumour enucleation, meticulous haemostasis and low-pressure inspection are highlighted as essential technical factors.
Clinical decision-making
The lecture concludes that successful surgery depends more on patient selection and intraoperative judgement than on adherence to a specific technique. Collecting system entry, uncontrolled bleeding or uncertain anatomy remain valid indications for repair or clamping when required.