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Robot-assisted partial nephrectomy: current status, techniques, and future directions

  • Urology – Review
  • Published:
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Abstract

Open partial nephrectomy for the treatment of small renal masses (SRMs) concerning for renal cell carcinoma has been increasingly utilized with the increased incidental detection of SRMs and the growing recognition of the benefits of renal preservation. Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that achieves comparable oncologic and improved morbidity outcomes when compared to the open procedure. However, LPN is a technically demanding procedure resulting in a long learning curve and a lack of widespread adoption. Robot-assisted partial nephrectomy (RAPN) overcomes many of the technical hurdles of the LPN and is now coming to the forefront for the minimally invasive surgical management of SRMs. To date, the short-term oncologic outcomes of RAPN have been comparable to the open operation while providing the improved morbidity outcomes of LPN. Although encouraging, we await the long-term oncologic results of this new and promising procedure. The current bottleneck is an issue of cost and reliance on a patient-side surgeon. Future developments in instrumentation, newer robots, cost reduction, more streamlined training, increased robotic experience, and adoption by more centers will lead to greater benefit for patients with SRMs requiring nephron-sparing surgery. This review will discuss techniques for RAPN and then delve into the current status of RAPN using parameters such as warm ischemia time, blood loss, hospital stay, oncological outcomes, complications, learning curve, and quality of life. There will be an exploration of potential disadvantages associated with RAPN followed by a look at evolving techniques in regard to this groundbreaking procedure.

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References

  1. Jemal A, Siegel R, Xu J et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300

    Article  PubMed  Google Scholar 

  2. Ates F, Akyol I, Sildiroglu O et al (2010) Preoperative imaging in renal masses: does size on computed tomography correlate with actual tumor size? Int Urol Nephrol 42(4):861–866

    Article  PubMed  Google Scholar 

  3. Tsui KH, Shvarts O, Smith RB et al (2000) Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol 163:426–430

    Article  PubMed  CAS  Google Scholar 

  4. Morrissey JJ, London AN, Luo J et al (2010) Urinary biomarkers for the early diagnosis of kidney cancer. Mayo Clin Proc 85:413–421

    Article  PubMed  CAS  Google Scholar 

  5. Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740

    Article  PubMed  Google Scholar 

  6. Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18

    Article  PubMed  CAS  Google Scholar 

  7. Lerner SE, Hawkins CA, Blute ML et al (1996) Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 155:1868–1873

    Article  PubMed  CAS  Google Scholar 

  8. Mitchell RE, Gilbert SM, Murphy AM et al (2006) Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology 67:260–264

    Article  PubMed  Google Scholar 

  9. Winfield HN, Donovan JF, Godet AS et al (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7:521–526

    Article  PubMed  CAS  Google Scholar 

  10. McDougall EM, Clayman RV, Chandhoke PS et al (1993) Laparoscopic partial nephrectomy in the pig model. J Urol 149:1633–1636

    PubMed  CAS  Google Scholar 

  11. Nouralizadeh A, Simforoosh N, Tabibi A et al (2010) Laparoscopic partial nephrectomy for tumours >4 cm compared with smaller tumours: perioperative results. Int Urol Nephrol. doi:10.1007/s11255-010-9812-x

  12. Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46

    Article  PubMed  Google Scholar 

  13. Gettman MT, Blute ML, Chow GK et al (2004) Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology 64:914–918

    Article  PubMed  Google Scholar 

  14. Benway BM, Bhayani SB, Rogers CG et al (2009) Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182:866–872

    Article  PubMed  Google Scholar 

  15. Patel MN, Krane LS, Bhandari A et al (2010) Robotic partial nephrectomy for renal tumors larger than 4 cm. Eur Urol 57:310–316

    Article  PubMed  Google Scholar 

  16. Hemal AK (2011) Laparoscopic Retroperitoneal Extirpative and Reconstructive Renal Surgery. J Endourol. doi:10.1089/end.2010.0697

  17. Kumar R, Hemal AK (2010) Retroperitoneal renal laparoscopy. Int Urol Nephrol. doi:10.1007/s11255-010-9882-9

  18. Colli J, Martin B, Purcell M et al (2010) Surgical factors affecting return of renal function after partial nephrectomy. Int Urol Nephrol. doi:10.1007/s11255-010-9764-1

  19. Scoll BJ, Uzzo RG, Chen DY et al (2010) Robot-assisted partial nephrectomy: a large single-institutional experience. Urology 75:1328–1334

    Article  PubMed  Google Scholar 

  20. Kural AR, Atug F, Tufek I et al (2009) Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: comparison of outcomes. J Endourol 23:1491–1497

    Article  PubMed  Google Scholar 

  21. Wang AJ, Bhayani SB (2009) Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single surgeon analysis of >100 consecutive procedures. Urology 73:306–310

    Article  PubMed  Google Scholar 

  22. Benway BM, Bhayani SB, Rogers CG et al (2010) Robot-assisted partial nephrectomy: an international experience. Eur Urol 57:815–820

    Article  PubMed  Google Scholar 

  23. Yang CK, Chiu KY, Su CK et al (2009) Initial clinical experience with surgical technique of robot-assisted transperitoneal laparoscopic partial nephrectomy. J Chin Med Assoc 72:634–637

    Article  PubMed  Google Scholar 

  24. Caruso RP, Phillips CK, Kau E et al (2006) Robot assisted laparoscopic partial nephrectomy: initial experience. J Urol 176:36–39

    Article  PubMed  Google Scholar 

  25. Haseebuddin M, Benway B, Cabello J et al (2010) Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol 24:57–61

    Article  PubMed  Google Scholar 

  26. Mottrie A, De Naeyer G, Schatteman P et al (2010) Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol 58:127–133

    Article  PubMed  Google Scholar 

  27. Gratzke C, Seitz M, Bayrle F et al (2009) Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma. BJU Int 104:470–475

    Article  PubMed  Google Scholar 

  28. Harryman OA, Davenport K, Keoghane S et al (2009) A comparative study of quality of life issues relating to open versus laparoscopic nephrectomy: a prospective pragmatic study. J Urol 181:998–1003

    Article  PubMed  Google Scholar 

  29. Kumar R, Hemal AK (2006) The ‘scrubbed surgeon’ in robotic surgery. World J Urol 24:144–147

    Article  PubMed  Google Scholar 

  30. Rogers CG, Laungani R, Bhandari A et al (2009) Maximizing console surgeon independence during robot-assisted renal surgery by using the fourth arm and tilepro. J Endourol 23:115–121

    Article  PubMed  Google Scholar 

  31. Gautam G, Benway BM, Bhayani SB et al (2009) Robot-assisted partial nephrectomy: current perspectives and future prospects. Urology 74:735–740

    Article  PubMed  Google Scholar 

  32. Viprakasit DP, Altamar HO, Miller NL et al (2010) Selective renal parenchymal clamping in robotic partial nephrectomy: initial experience. Urology 76:750–753

    Google Scholar 

  33. Wu SD, Viprakasit DP, Cashy J et al (2010) Radiofrequency ablation-assisted robotic laparoscopic partial nephrectomy without renal hilar vessel clamping versus laparoscopic partial nephrectomy: a comparison of perioperative outcomes. J Endourol 24:385–391

    Article  PubMed  Google Scholar 

  34. White WM, Goel RK, Haber GP et al (2010) Robotic partial nephrectomy without renal hilar occlusion. BJU Int 105:1580–1584

    Article  PubMed  Google Scholar 

  35. Shingu C, Koga H, Hagiwara S et al (2010) Hydrogen-rich saline solution attenuates renal ischemia-reperfusion injury. J Anesth 24:569–574

    Google Scholar 

  36. Kaouk JH, White WM, Goel RK et al (2009) NOTES transvaginal nephrectomy: first human experience. Urology 74:5–8

    Article  PubMed  Google Scholar 

  37. Haber GP, Crouzet S, Kamoi K et al (2008) Robotic NOTES (natural orifice translumenal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000

    Article  PubMed  Google Scholar 

  38. Phillips CK, Taneja SS, Stifelman MD (2005) Robot-assisted laparoscopic partial nephrectomy: the NYU technique. J Endourol 19:441–445

    Article  PubMed  Google Scholar 

  39. Ho HS, Peschel R, Neururer R et al (2008) Another novel application of Hem-o-Lok clips for transient vascular occlusion in robot-assisted laparoscopic partial nephrectomy: an alternative to laparoscopic bulldog and satinsky clamps. J Endourol 22:1677–1680

    Article  PubMed  Google Scholar 

  40. Rogers CG, Menon M, Weise ES et al (2008) Robotic partial nephrectomy: a multiinstitutional analysis. J Robotic Surg 2:141–143

    Article  Google Scholar 

  41. Aron M, Koenig P, Kaouk JH et al (2008) Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre. BJU Int 102:86–92

    Article  PubMed  Google Scholar 

  42. Deane LA, Lee HJ, Box GN et al (2008) Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. J Endourol 22:947–952

    Article  PubMed  Google Scholar 

  43. Michli EE, Parra RO (2009) Robotic-assisted laparoscopic partial nephrectomy: initial clinical experience. Urology 73:302–305

    Article  PubMed  Google Scholar 

  44. Gong Y, Du C, Josephson DY et al (2010) Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol 28:111–115

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology and Institute of Regenerative Medicine, Robotics and Minimally Invasive Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1094, USA

    Paurush Babbar & Ashok K. Hemal

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  1. Paurush Babbar
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  2. Ashok K. Hemal
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Correspondence to Ashok K. Hemal.

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Babbar, P., Hemal, A.K. Robot-assisted partial nephrectomy: current status, techniques, and future directions. Int Urol Nephrol 44, 99–109 (2012). https://doi.org/10.1007/s11255-011-9900-6

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  • DOI: https://doi.org/10.1007/s11255-011-9900-6

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