{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:28:02Z","timestamp":1785421682704,"version":"3.56.0"},"reference-count":43,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU"},{"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Robot-assisted partial nephrectomy (RAPN) is an established nephron-sparing technique for localized renal tumors. It is performed using on-clamp (temporary renal artery clamping) or off-clamp (without hilar clamping) strategies. Comparative real-world evidence remains limited and is often confounded by non-randomized treatment allocation. Methods: This retrospective single-center study included 146 consecutive patients undergoing RAPN between 2020 and 2025. Patients were allocated to on-clamp (n = 108) or off-clamp (n = 38) groups based on tumor characteristics and intraoperative surgeon judgment. Perioperative, functional, and early oncological outcomes were analyzed. Tumor complexity was assessed using the RENAL nephrometry score. Surgical quality was evaluated using the Trifecta outcome (negative margins, warm ischemia time \u226425 min, and absence of Clavien\u2013Dindo \u2265III complications). Results: Off-clamp RAPN was more frequently applied in smaller tumors (p = 0.008), while RENAL scores were comparable between groups. Estimated blood loss was higher in the off-clamp group (260 \u00b1 62 vs. 110 \u00b1 35 mL; p &lt; 0.0001), whereas transfusion rates and overall complication rates did not differ significantly. Trifecta achievement was similar between on-clamp and off-clamp RAPN (91.0% vs. 96.8%; p = 0.45). No significant differences were observed in early postoperative renal function (creatinine, hemoglobin, eGFR) or positive surgical margin rates. Conclusions: In this retrospective cohort, both on-clamp and off-clamp RAPN demonstrated comparable perioperative safety, functional outcomes, and early oncological efficacy. Differences in baseline tumor characteristics reflect selection bias rather than treatment effect. These findings support the feasibility of both techniques in appropriately selected patients, while highlighting the need for prospective comparative studies with adjustment for confounding factors.<\/jats:p>","DOI":"10.3390\/diagnostics16101543","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:17:23Z","timestamp":1779203843000},"page":"1543","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["On-Clamp Versus Off-Clamp Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: A Retrospective Single-Center Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0528-0289","authenticated-orcid":false,"given":"Stanila","family":"Stoeva-Grigorova","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9573-0593","authenticated-orcid":false,"given":"Simeon","family":"Marinov","sequence":"additional","affiliation":[{"name":"Clinic of Urology, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"},{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Abushev","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Plamen","family":"Kirilov","sequence":"additional","affiliation":[{"name":"Clinic of Urology, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"},{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doychin","family":"Nikolov","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turgay","family":"Kalinov","sequence":"additional","affiliation":[{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Department of General and Operative Surgery, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"First Clinic of Surgery, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Kolev","sequence":"additional","affiliation":[{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Department of General and Operative Surgery, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"First Clinic of Surgery, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Zlatarov","sequence":"additional","affiliation":[{"name":"Centre of Competence in Personalized Medicine, 3D and Telemedicine, Robotic-Assisted and Minimally Invasive Surgery \u201cLeonardo da Vinci\u201d, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Department of General and Operative Surgery, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"First Clinic of Surgery, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyuben","family":"Stoev","sequence":"additional","affiliation":[{"name":"Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinic of General and Clinical Pathology, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deyan","family":"Dzhenkov","sequence":"additional","affiliation":[{"name":"Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinic of General and Clinical Pathology, University Hospital \u201cSt. Marina\u201d, 9010 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Robot-assisted urologic surgery in 2010\u2014Advancements and future outlook","volume":"3","author":"Babbar","year":"2011","journal-title":"Urol. 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