Trial reportWorld journal of urology2023
The role of warm ischemia time on functional outcomes after robotic partial nephrectomy: a radionuclide renal scan study from the clock randomized trial.
Trial report in World journal of urology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Adjunctive topical hemostatic agents combined with renorrhaphy versus renorrhaphy alone during partial nephrectomy: a systematic review and meta-analysis.World journal of urology · 2026Pooled it
- Robot-assisted and embolization-assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal angiomyolipoma: a systematic review and meta-analysis.Journal of robotic surgery · 2025Pooled it
- The impact of warm ischemia time on short-term renal function after partial nephrectomy: a systematic review and meta-analysis.BMC urology · 2025Pooled it
- Research evolution of ischemia management and vascular control strategies in robot-assisted partial nephrectomy: a bibliometric and knowledge-mapping analysis.Journal of robotic surgery · 2026Review
- Anatomy and patient comorbidity in robotic partial nephrectomy: predictors of complexity and outcomes.Journal of robotic surgery · 2026Article
- 3D surgical navigation contributes to renal function preservation during robot-assisted partial nephrectomy.Journal of robotic surgery · 2026Article
- Early Biohumoral Detection of Acute Kidney Injury After Robotic Renal Surgery and Its Impact on Medium-Term Renal Function.International journal of molecular sciences · 2026Article
- Selective Artery Clamping Superior to Main Artery Clamping in Preserving Ipsilateral Renal Function after Minimally Invasive Partial Nephrectomy under Prolonged Warm Ischemia.Annals of surgical oncology · 2026Article
- Article
- Differentiating Malignant and Healthy Areas in Isolated Kidney Samples Through Infrared Visualization Techniques.World journal of oncology · 2025Article
- Accuracy of warm ischemia time measurement using a surgical intelligence software in partial nephrectomies: A validation study.BJUI compass · 2024Article
- Hyper accuracy three-dimensional virtual anatomical rainbow model facilitates surgical planning and safe selective clamping during robot-assisted partial nephrectomy.Asian journal of urology · 2024Article
- Seeking for the determinants of renal function loss after robot-assisted partial nephrectomy: what is below the tip of the iceberg.Journal of robotic surgery · 2024Article
- Comparing Perioperative Complications of Off-Clamp versus On-Clamp Partial Nephrectomy for Renal Cancer Using a Novel Energy Balancing Weights Method.Life (Basel, Switzerland) · 2024Article
- Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique.European urology open science · 2023Article
- Can the Abdominal Aortic Atherosclerotic Plaque Index Predict Functional Outcomes after Robot-Assisted Partial Nephrectomy?Diagnostics (Basel, Switzerland) · 2023Article
- How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy?Frontiers in surgery · 2023Article
Corrections and comments
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate the relationship between warm ischemia time (WIT) duration and renal function after robot-assisted partial nephrectomy (RAPN).
methodsThe CLOCK trial is a phase 3 randomized controlled trial comparing on- vs off-clamp RAPN. All patients underwent pre- and postoperative renal scintigraphy. Six-month absolute variation of eGFR (AV-GFR), rate of relative variation in eGFR over 25% (RV-GFR > 25), absolute variation of split renal function (SRF) at scintigraphy (AV-SRF). The relationships WIT/outcomes were assessed by correlation graphs and then modeled by uni- and multivariable regression.
results324 patients were included (206 on-clamp, 118 off-clamp RAPN). Correlation graphs showed a threshold on WIT equal to 10 min. The differences in outcome measures between cases with WIT < vs ≥ 10 min were: AV-GFR - 3.7 vs - 7.5 ml/min (p < 0.001); AV-SRF - 1% vs - 3.6% (p < 0.001); RV-GFR > 25 9.3% vs 17.8% (p = 0.008). Multivariable models found that AV-GFR was related to WIT ≥ 10 min (regression coefficient [RC] - 0.52, p = 0.019), age (RC - 0.35, p = 0.001) and baseline eGFR (RC - 0.30, p < 0.001); RV-GFR > 25 to WIT ≥ 10 min (odds ratio [OR] 1.11, p = 0.007) and acute kidney injury defined as > 50% increase in serum creatinine (OR 19.7, p = 0.009); AV-SRF to WIT ≥ 10 min (RC - 0.30, p = 0.018), baseline SRF (RC - 0.76, p < 0.001) and RENAL score (RC - 0.60. p = 0.028). The main limitation was that the CLOCK trial was designed on a different endpoint and therefore the present analysis could be underpowered.
conclusionsUp to 10 min WIT had no consequences on functional outcomes. Above the 10-min threshold, a statistically significant, but clinically negligible impact was found.
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