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Simplified robot-assisted partial nephrectomy: step-by-step technique and perioperative outcomes

  • Benjamin Pradere
  • Benoit Peyronnet
  • Zine-eddine Khene
  • Romain Mathieu
  • Gregory Verhoest
  • Karim Bensalah
Original Article
  • 21 Downloads

Abstract

Controversies have been raised and still exist regarding several technical aspects of robot-assisted partial nephrectomy (RAPN). While the “perfect RAPN” has still to be determined, we aimed to report a simplified technique of RAPN in a step-by-step fashion and the perioperative outcomes of a single-center series. A simplified technique of RAPN was developed, refined and standardized over the past 7 years in an academic department of urology to make it as safe and as reproducible as possible, the main goal being to make it an “easy to learn” technique for fellows. This technique is presented in 12 key steps. The patients’ characteristics and perioperative outcomes were prospectively collected and are reported herein. Since the first case performed in our department in 2010, 406 patients have undergone RAPN with a standardized and stable simplified technique after the first 30 cases, involving several key steps including systematic use of the transperitoneal approach, minimal visceral mobilization of the colon, systematic psoas exposure and ureter identification, minimal dissection of the perinephric fat, arterial clamping with early unclamping, no use of hemostatic agents or drain. The majority of RAPN were performed by surgeons with either low experience (i.e., < 20 procedures; 46.3%) or intermediate experience (i.e., 20–50 procedures; 17.2%). The mean warm ischemia time was 15.3 min. Conversions to an open approach and to radical nephrectomy were required in 14 (3.5%) and 21 (5.2%) cases, respectively. From 132 patients who experienced post-operative complications (32.5%), 47 experienced a major complication (11.6%). The positive surgical margin rate was 5.6%. The simplified technique of RAPN was feasible and reproducible with satisfactory perioperative outcomes. Most of the key steps have been assessed through single-center and multicenter clinical studies.

Keywords

Kidney neoplasm Partial nephrectomy Surgery Robotic surgery 

Notes

Compliance with ethical standards

Conflict of interest

Karim Bensalah and Gregory Verhoest are proctors for Intuitive Surgical®. Other authors have nothing to disclose.

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyCHU RennesRennesFrance

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