Robot-assisted Partial Nephrectomy for Endophytic Tumors


Robot-assisted partial nephrectomy (RAPN) has gained increasing popularity in the management of renal masses due to its technical feasibility and shorter learning curve with superior perioperative outcomes compared to laparoscopic partial nephrectomy (LPN). Given the cumulation of surgical experience on RAPN, the indication for RAPN has been extended to more challenging, complex cases, such as hilar or endophytic tumors. Renal masses that are completely endophytic can be very challenging to surgeons. These cases are associated with poor recognition of mass extension, higher risk of inadvertent vascular, or pelvicalyceal system injury. As a result, this can lead to potential positive surgical margin, difficulty in performing renorrhaphy as well as higher perioperative complication rates. There is few evidence of oncologic and functional outcomes of RAPN on treating endophytic masses. Therefore, the objective of this review is to critically analyze the current evidence and to provide a summary on the outcomes of RAPN for endophytic renal masses.

This is a preview of subscription content, access via your institution.

Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–61.

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.

    Article  PubMed  Google Scholar 

  3. 3.

    Patel HD, Mullins JK, Pierorazio PM, Jayram G, Cohen JE, Matlaga BR, et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. 2013;189(4):1229–35.

    Article  PubMed  Google Scholar 

  4. 4.

    White MA, Haber GP, Autorino R, Khanna R, Hernandez AV, Forest S, et al. Outcomes of robotic partial nephrectomy for renal masses with nephrometry score of ≥7. Urology. 2011;77(4):809–13.

    Article  PubMed  Google Scholar 

  5. 5.•

    Long JA, Yakoubi R, Lee B, Guillotreau J, Autorino R, Laydner H, et al. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. Eur Urol. 2012;61(6):1257–62. A retrospective study perioperative outcomes between robotic partial nephrectomy and laparoscopic partial nephrectomyfor complex tumors. Robotic partial nephrectomy provides functional outcomes comparable to those of laparoscopic partial nephrectomy for moderate- to high-complexity tumors, with a significantly lower risk of conversion to radical nephrectomy.

    Article  PubMed  Google Scholar 

  6. 6.

    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.

    Article  PubMed  Google Scholar 

  7. 7.

    Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.

    Article  PubMed  Google Scholar 

  8. 8.

    Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS. Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol. 2008;179(3):847–51.

    Article  PubMed  Google Scholar 

  9. 9.

    Reifsnyder JE, Ramasamy R, Ng CK, Dipietro J, Shin B, Shariat SF, et al. Laparoscopic and open partial nephrectomy: complication comparison using the clavien system. J Soc Laparoendosc Surg. 2012;16(1):38–44.

    Article  Google Scholar 

  10. 10.

    Matin SF, Gill IS. Laparoscopic ultrasonography. J Endourol. 2001;15(1):87–92.

    CAS  Article  PubMed  Google Scholar 

  11. 11.•

    Fazio LM, Downey D, Nguan CY, Karnik V, Al-Omar M, Kwan K, et al. Intraoperative laparoscopic renal ultrasonography: use in advanced laparoscopic renal surgery. Urology. 2006;68(4):723–7. An article to highlight the use of intraoperative laparoscopic ultrasonography in complex renal surgery, as well its impact on management. It is useful in advanced laparoscopic renal surgery.

    Article  PubMed  Google Scholar 

  12. 12.

    Di Pierro GB, Tartaglia N, Aresu L, Polara A, Cielo A, Cristini C, et al. Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes. Eur J Surg Oncol. 2014;40(6):769–74.

    Article  PubMed  Google Scholar 

  13. 13.•

    Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology. 2004;64(5):914–8. An article to assess the feasibility of laparoscopic partial nephrectomy performed using the daVinci robotic system. Robotic-assisted partial nephrectomy proved to be feasible and safely performed using a transperitoneal or retroperitoneal approach.

    Article  PubMed  Google Scholar 

  14. 14.•

    Assimos DG, Boyce H, Woodruff RD, Harrison LH, McCullough DL, Kroovand RL. Intraoperative renal ultrasonography: a useful adjunct to partial nephrectomy. J Urol. 1991;146(5):1218–20. An article of intraoperative renal ultrasonography using for intrarenal surgery. The author investigated its use undergoing partial nephrectomy for treatment of renal cell carcinoma. Intraoperative renal ultrasonography helps to identify the location and extent of deep intraparenchymal lesions.

    CAS  PubMed  Google Scholar 

  15. 15.•

    Kaczmarek BF, Sukumar S, Kumar RK, Desa N, Jost K, Diaz M, et al. Comparison of robotic and laparoscopic ultrasound probes for robotic partial nephrectomy. J Endourol. 2013;27(9):1137–40. A retrospective study to evaluate and compare perioperative outcomes of robotic partial nephrectomy using robotic and laparoscopic ultrasound probe for tumor identification. Robotic ultrasound probes for tumor identification during robotic partial nephrectomy had comparable perioperative outcomes and surgical margin rates as a laparoscopic ultrasound probe.

    Article  PubMed  Google Scholar 

  16. 16.••

    Kaczmarek BF, Sukumar S, Petros F, Trinh QD, Mander N, Chen R, et al. Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: initial series and outcomes. Int J Urol. 2013;20(2):172–6. An article of initial experience using a robotic ultrasound probe that is controlled by the console surgeon. The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument.

    Article  PubMed  Google Scholar 

  17. 17.

    Hyams ES, Kanofsky JA, Stifelman MD. Laparoscopic doppler technology: applications in laparoscopic pyeloplasty and radical and partial nephrectomy. Urology. 2008;71(5):952–6.

    Article  PubMed  Google Scholar 

  18. 18.•

    Furukawa J, Miyake H, Tanaka K, Sugimoto M, Fujisawa M. Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases. Int J Med Rob. 2014;10(4):385–90. An article of early experience with robot-assisted partial nephrectomy incorporating selective arterial clamping, using an image overlay navigation system. The intraoperative image overlay navigation system made it possible to clearly show the tumour position and vascular supply within the console’s field of view.

    Article  Google Scholar 

  19. 19.••

    Hughes-Hallett A, Pratt P, Mayer E, Martin S, Darzi A, Vale J. Image guidance for all--TilePro display of 3-dimensionally reconstructed images in robotic partial nephrectomy. Urology. 2014;84(1):237–42. An article to determine the feasibility of a novel low-barrier-to-entry image guidance system. The iPad-based system was able to achieve adequate alignment accuracy in significantly less time than the 3-dimensional mouse interface.

    Article  PubMed  Google Scholar 

  20. 20.•

    Tobis S, Knopf JK, Silvers C, Messing E, Yao J, Rashid H, et al. Robot-assisted and laparoscopic partial nephrectomy with near infrared fluorescence imaging. J Endourol. 2012;26(7):797–802. A study of the feasibility of a novel intraoperative imaging technique to differentiate tumor from surrounding parenchyma during laparoscopic and robot-assisted partial nephrectomy. Malignant masses were seen to be hypofluorescent compared with surrounding renal parenchyma during intraoperative imaging. The imaging behavior of benign tumors ranged from isofluorescent to hyperfluorescent compared with normal parenchyma.

    Article  PubMed  Google Scholar 

  21. 21.••

    Bjurlin MA, Gan M, McClintock TR, Volpe A, Borofsky MS, Mottrie A, et al. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol. 2014;65(4):793–801. An article to describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of near-infrared fluorescence imaging.

    Article  PubMed  Google Scholar 

  22. 22.•

    Autorino R, Zargar H, White WM, Novara G, Annino F, Perdonà S, et al. Current applications of near-infrared fluorescence imaging in robotic urologic surgery: a systematic review and critical analysis of the literature. Urology. 2014;84(4):751–9. A systematic review and critical analysis of the current evidence on the applications of near-infrared fluorescence in robotic urologic surgery. This technology can be of aid in visually defining the surgical anatomy, ultimately facilitating the task of the console surgeon.

    Article  PubMed  Google Scholar 

  23. 23.

    Merseburger AS, Herrmann TR, Shariat SF, Kyriazis I, Nagele U, Traxer O, et al. EAU guidelines on robotic and single-site surgery in urology. Eur Urol. 2013;64(2):277–91.

    Article  PubMed  Google Scholar 

  24. 24.••

    Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R, et al. Robot-assisted partial nephrectomy (RAPN) for completely endophytic renal masses: a single institution experience. BJU Int. 2014;113(5):762–8. An article to analyse the outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumours. Concluding that robot-assisted partial nephrectomy for completely intraparenchymal renal tumours can be safely and effectively performed, with surgical outcomes resembling those obtained in the general population.

    Article  PubMed  Google Scholar 

  25. 25.••

    Komninos C, Shin TY, Tuliao P, Kim DK, Han WK, Chung BH, et al. Robotic partial nephrectomy for completely endophytic renal tumors: complications and functional and oncologic outcomes during a 4-year median period of follow-up. Urology. 2014;84(6):1367–73. Retrospective study of 45 patients with completely endophytic tumors after robotic-assisted laparoscopic partial nephrectomy of complication rates, functional and oncologic outcomes during an intermediate-term period of follow-up.

    Article  PubMed  Google Scholar 

  26. 26.••

    Curtiss KM, Ball MW, Gorin MA, Harris KT, Pierorazio PM, Allaf ME. Perioperative outcomes of robotic partial nephrectomy for intrarenal tumors. J Endourol. 2015;29(3):293–6. An article to evaluate the safety, feasibility, and comparative effectiveness of robot-assisted partial nephrectomy in the management of completely intrarenal tumors facilitated by intraoperative ultrasonography.

    Article  PubMed  Google Scholar 

  27. 27.

    Boylu U, Basatac C, Yildirim U, Onol FF, Gumus E. Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy. J Minim Access Surg. 2015;11(1):72–7.

    PubMed Central  Article  PubMed  Google Scholar 

  28. 28.

    Ficarra V, Minervini A, Antonelli A, Bhayani S, Guazzoni G, Longo N, et al. A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int. 2014;113(6):936–41.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Gill IS, Colombo JR, Frank I, Moinzadeh A, Kaouk J, Desai M. Laparoscopic partial nephrectomy for hilar tumors. J Urol. 2005;174(3):850–3.

    Article  PubMed  Google Scholar 

  30. 30.••

    Eyraud R, Long JA, Snow-Lisy D, Autorino R, Hillyer S, Klink J, et al. Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes. Urology. 2013;81(6):1246–51. An article to compare perioperative outcomes of robot-assisted partial nephrectomy for hilar vs nonhilar tumors. Hilar tumor is not associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function.

    Article  PubMed  Google Scholar 

  31. 31.•

    Abreu AL, Gill IS, Desai MM. Zero-ischaemia robotic partial nephrectomy (RPN) for hilar tumours. BJU Int. 2011;108:948–54. A study of detail technique and initial perioperative outcomes of novel technique of zero-ischaemia robot-assisted partial nephrectomy for complex hilar tumours. Elimination of warm ischemia could optimally preserve renal function.

    Article  PubMed  Google Scholar 

  32. 32.••

    Miyake H, Hinata N, Imai S, Furukawa J, Tanaka K, Fujisawa M. Partial nephrectomy for hilar tumors: comparison of conventional open and robot-assisted approaches. Int J Clin Oncol. 2015;20:808–13. A study to characterize clinical advantages in robot-assisted partial nephrectomy for targeting renal hilar tumors, and compare them with those of open partial nephrectomy.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Koon Ho Rha.

Ethics declarations

Conflict of Interest

Dr. Dae Keun Kim, Dr. Christos Komninos, Dr. Lawrence Kim, and Dr. Koon Ho Rha reported no potential conflict of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Kidney Diseases

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, D.K., Komninos, C., Kim, L. et al. Robot-assisted Partial Nephrectomy for Endophytic Tumors. Curr Urol Rep 16, 76 (2015).

Download citation


  • Robot-assisted partial nephrectomy
  • Renal mass
  • Endophytic mass
  • Nephron sparing surgery