Abstract and Background
Abstract
Background: A standard of care for the treatment of small renal masses is partial nephrectomy. The open and laparoscopic approaches have been well described in the literature. Robotic assistance may augment partial nephrectomy by aiding in dissection and renal reconstruction. In this communication we describe the surgical outcomes of 35 patients undergoing robotic partial nephrectomy.
Methods: Patient records and databases were reviewed for 35 consecutive patients undergoing RPN. Clinical, pathological, and radiographic data were obtained. The data was deidentified.
Results: Thirty five patients successfully underwent RPN. An additional 2 patients were converted to other nephron sparing procedures. Mean tumor size was 2.8cm, and mean OR time was 142 minutes. Mean warm ischemia time was 20 minutes. All margins were negative. There were 4 complications, and no patients required reoperation.
Conclusion: Robotic partial nephrectomy can produce excellent initial results. Further studies should be performed to compare the outcomes to laparoscopic and open operations.
Background
The small suspicious renal mass may be treated with a variety of modalities. Open radical nephrectomy is the traditional treatment for a renal neoplasm, but open partial nephrectomy has evolved into a standard of care, with the obvious advantage of sparing the kidney. In the 1990s laparoscopic approaches to partial nephrectomy were developed. The laparoscopic partial nephrectomy has been performed in centers of excellence with reasonable results. However, the operation has also been thought to be technically advanced secondary to the laparoscopic reconstructive skills necessary to perform the procedure quickly while the kidney is under warm ischemia.
Robotic surgical assistance has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robotic radical prostatectomy has become the prime example in which a complex open procedure may be reproduced with robotic assistance in a minimally invasive fashion. The da Vinci robot (Intuitive Surgical, Sunnyvale, CA, USA) allows ease of intracorporeal dissection and suturing secondary to the wristed and articulating instrumentation. To date, the robotic system has been sparsely reported as an adjunct to laparoscopic partial nephrectomy. In this series, we report the outcomes of 35 patients undergoing robotic assisted laparoscopic partial nephrectomy (RPN), which represents one of the largest series.