# Use of Radiofrequency in Robot-Assisted Partial Nephrectomy for Small Tumors: A Novel Technique

## TL;DR

This paper introduces a new technique using radiofrequency ablation instead of clamping during robot-assisted kidney surgery for small tumors, showing fewer complications and good outcomes.

## Contribution

The paper presents a novel technique using radiofrequency ablation for hemostasis in robot-assisted partial nephrectomy without clamping.

## Key findings

- The technique resulted in low hemorrhagic complications (2.2%) and minimal blood loss (median 15 mL).
- No tumor recurrence was observed at the treated site during a median follow-up of 48.2 months.
- Renal function remained stable with no significant decline in creatinine clearance.

## Abstract

Introduction and Objectives: Radiofrequency is standardized for ablating small renal tumors, but evidence regarding its effects remains limited. Partial nephrectomy, the gold standard, often leads to hemorrhagic complications and irreversible renal damage due to hilum clamping. To mitigate these risks, we propose a novel technique that replaces clamping with radiofrequency ablation of the tumor for hemostasis in robot-assisted partial nephrectomy. Methods: We report on 357 consecutive patients with T1a renal tumors treated with robot-assisted surgery between 2010 and July 2024. Radiofrequency was used peri-tumorally for hemostasis, followed by complete lesion enucleation. Follow-up included ultrasound and creatinine at 1 month, CT scans at months 3 and 9, and then annually for 5 years. Results: The median age was 60.2 years, with 251 men (70.3%). The median tumor size was 22 mm, and the median blood loss was 15 mL. Hemorrhagic complications occurred in eight patients (2.2%), with one requiring a blood transfusion (0.28%). A total of 30 patients experienced transient stage 1 acute kidney disease (8.4%), with no significant change in median 74.92 mL/min/1.77 m2 vs. 78.77 mL/min/1.77 m2 vs. (p-value 0.15). The median follow-up was 48.2 months, with no tumor recurrence at the treated site. Renal cell carcinoma was found in 83.7% of tumors. Conclusions: To our knowledge, this series represent the largest global undertaking of renal tumor treatment using peripheral radiofrequency ablation without clamping, demonstrating optimal surgical and oncological outcomes, lower morbidity, and fewer complications compared to those noted in the revised literature regarding traditional clamping techniques.