Articles

Robot-Assisted Partial Nephrectomy: An International Experience

By: Brian M. Benwaya lowast , Sam B. Bhayania, Craig G. Rogersb, James R. Porterc, Nicolò M. Buffid, Robert S. Figenshaua and Alexandre Mottriee

Published online: 01 May 2010

Keywords: Robot-assisted partial nephrectomy, RAPN, Robotic partial nephrectomy, Partial nephrectomy, Nephrectomy, Nephron-sparing surgery, NSS, Warm ischemia time, Warm ischemic time, Renorrhaphy, Minimally-invasive, Laparoscopic, da Vinci

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Abstract

Background

Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients.

Objective

We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and oncologic outcomes.

Design, setting, and participants

A retrospective chart review was performed for 183 patients who underwent RAPN at four centers between 2006 and 2008.

Surgical procedure

RAPN was performed using methods outlined in the supplemental video material. Though operative technique was similar across all institutions, there were minor variations in trocar placement and hilar control.

Measurements

Perioperative parameters, including operative time, warm ischemic time, blood loss, and perioperative complications were recorded. In addition, we reviewed functional and oncologic outcomes.

Results and limitations

Mean age at treatment was 59.3 yr. Mean tumor size was 2.87cm. Mean total operative time was 210min while mean ischemic time was 23.9min. Calyceal repair was required in 52.1% of procedures. Mean estimated blood loss was 131.5ml. Sixty-nine percent of excised tumors were malignant, of which 2.7% exhibited positive surgical margins. The incidence of major complications was 8.2%. At up to 26 mo follow-up, there have been no documented recurrences and no significant change in serum creatinine (1.03 vs 1.04mg/dl, p=0.84) or estimated glomerular filtration rate (eGFR) from baseline (82.2 vs 79.4mg/ml per square meter, p=0.74). The study is limited by its retrospective nature, and the outcomes are likely influenced by the robust prior laparoscopic renal experience of each of the surgeons included in this study.

Conclusions

RAPN is a safe and efficacious approach for NSS, offering short ischemic times, as well as perioperative morbidity equivalent to other standard approaches. Moreover, RAPN is capable of providing patients with excellent functional and oncologic outcomes.

Take Home Message

In this paper, we describe the largest multicenter robot-assisted partial nephrectomy experience to date, demonstrating favorable operative parameters as well as excellent intermediate-term oncologic and functional outcomes.

Keywords: Robot-assisted partial nephrectomy, RAPN, Robotic partial nephrectomy, Partial nephrectomy, Nephrectomy, Nephron-sparing surgery, NSS, Warm ischemia time, Warm ischemic time, Renorrhaphy, Minimally-invasive, Laparoscopic, da Vinci.

Footnotes

a Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA

b Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

c Swedish Urology Group, Seattle, WA, USA

d Department of Urology, Vita-Salute University, San Raffaele–Turro Hospital, Milan, Italy

e Department of Urology, Onze Lieve Vrouwziekenhuis, Aalst, Belgium

lowast Corresponding author. Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA. Tel. +1 314 747 0888; Fax: +1 314 454 2876.