Skip to main content

Advertisement

SpringerLink
Log in

Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6–54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique. Challenging situations are hilar, posterior or intraparenchymal tumour localization. In our experience, robotic technology made possible a safe minimally invasive management, including vascular clamping, tumour resection and parenchyma reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pantuck AJ, Zisman A, Belldegrun AS (2001) The changing natural history of renal cell carcinoma. J Urol 166:1611–1623

    Article  PubMed  CAS  Google Scholar 

  2. Homma Y, Kawabe K, Kitamura T, Nishimura Y, Shinohara M, Kondo Y, Saito I, Minowada S, Asakage Y (1995) Increased incidental detection and reduced mortality in renal cancer: recent retrospective analysis at eight institutions. Int J Urol 2:77–80

    Article  PubMed  CAS  Google Scholar 

  3. Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51:203–205

    Article  PubMed  CAS  Google Scholar 

  4. Bretheau D, Lechevallier E, Eghazarian C, Grisoni V, Coulange C (1995) Prognostic significance of incidental renal cell carcinoma. Eur Urol 27:319–323

    PubMed  CAS  Google Scholar 

  5. Tsui KH, Shvarts O, Smith RB, Figlin R, de Kernion JB, Belldegrun A (2000) Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol 163:426–430

    Article  PubMed  CAS  Google Scholar 

  6. Janetschek G, Abdelmaksoud AA (2003) Laparoscopic wedge resection for renal cell carcinoma. Curr Opin Urol 13:203–208

    Article  PubMed  Google Scholar 

  7. Bosniak MA (1991) The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 179:307–317

    PubMed  CAS  Google Scholar 

  8. Bosniak MA, Birnbaum BA, Krinsky GA, Waisman J (1995) Small renal parenchymal neoplasms: further observations on growth. Radiology 197:589–597

    PubMed  CAS  Google Scholar 

  9. Fergany AF, Hafez KS, Novick AC (2000) Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow-up. J Urol 163:442–445

    Article  PubMed  CAS  Google Scholar 

  10. Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P (2000) Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 163:730–736

    Article  PubMed  CAS  Google Scholar 

  11. McKiernan J, Simmons R, Katz J, Russo P (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59:816–820

    Article  PubMed  Google Scholar 

  12. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75:1236–1242

    Article  PubMed  CAS  Google Scholar 

  13. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC, European Association of Urology Guideline Group (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406

    Article  PubMed  Google Scholar 

  14. Fujioka T, Obara W, Committee for Establishment of the Clinical Practice Guideline for the Management of Renal Cell Carcinoma and the Japanese Urological Association (2012) Evidence-based clinical practice guideline for renal cell carcinoma: the Japanese Urological Association 2011 update. Int J Urol 19:496–503

    Article  PubMed  Google Scholar 

  15. McDougall EM, Clayman RV, Chandhoke PS, Kerbl K, Stone AM, Wick MR, Hicks M, Figenshau RS (1993) Laparoscopic partial nephrectomy in the pig model. J Urol 149:1633–1636

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  17. Janetschek G, Abdelmaksoud A, Bagheri F, Al-Zahrani H, Leeb K, Gschwendtner M (2004) Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 171:68–71

    Article  PubMed  Google Scholar 

  18. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46

    Article  PubMed  Google Scholar 

  19. Tsivian M, Ulusoy S, Abern MR, Wandel A, Sidi AA, Tsivian A (2012) Renal mass anatomical characteristics and perioperative outcomes of laparoscopic partial nephrectomy: a critical analysis. J Endourol 26:1307–1313

    Article  PubMed  Google Scholar 

  20. Cabello JM, Benway BM, Bhayani SB (2009) Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy. Int Braz J Urol 35:199–204

    Article  PubMed  Google Scholar 

  21. Benway BM, Wang AJ, Cabello JM, Bhayani SB (2009) Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol 55:592–599

    Article  PubMed  Google Scholar 

  22. Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Patil MB, Campese V, Thangathurai D, Desai MM (2011) “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 59:128–134

    Article  PubMed  Google Scholar 

  23. Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT (2006) National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 67:254–259

    Article  PubMed  Google Scholar 

  24. Luciani LG, Cestari R, Tallarigo C (2000) Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 56:58–62

    Article  PubMed  CAS  Google Scholar 

  25. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumors: a retrospective cohort study. Lancet Oncol 7:735–740

    Article  PubMed  Google Scholar 

  26. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305

    Article  PubMed  CAS  Google Scholar 

  27. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282

    PubMed  CAS  Google Scholar 

  28. Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, Thornton J, Sherief MH, Strzempkowski B, Novick AC (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68

    Article  PubMed  Google Scholar 

  29. Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741

    Article  PubMed  Google Scholar 

  30. Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R (2004) Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology 64:914–918

    Article  PubMed  Google Scholar 

  31. Stifelman MD, Caruso RP, Nieder AM, Taneja SS (2005) Robot-assisted laparoscopic partial nephrectomy. JSLS 9:83–86

    PubMed  Google Scholar 

  32. Deane LA, Lee HJ, Box GN, Melamud O, Yee DS, Abrham JBA, Finley DS, Borin JF, McDougall EM, Clayman RV, Ornstein DK (2008) Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. J Endourol 22:1–6

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  34. Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA (2008) Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 53:514–521

    Article  PubMed  Google Scholar 

  35. Kaul S, Laungani R, Sarle R, Stricker H, Peabody J, Littleton R, Menon M (2007) da Vinci-assisted robotic partial and results at a mean of 15 months of follow-up. Eur Urol 51:186–191

    Article  PubMed  Google Scholar 

  36. Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, Novick AC (2002) Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 167:469–476

    Google Scholar 

  37. Deane LA, Lee HJ, Box GN, Melamud O, Yee DS, Abraham JB, Finley DS, Borin JF, McDougall EM, Clayman RV, Ornstein DK (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 

  38. Patel HD, Mullins JK, Pierorazio PM, Jayram G, Cohen JE, Matlaga BR, Allaf ME (2012) Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol. doi:10.1016/j.juro.2012.10.024 [Epub ahead of print]

  39. Matin SF, Gill IS, Worley S, Novick AC (2002) Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm or less renal tumor with a normal contralateral kidney. J Urol 168:1356–1360

    Article  PubMed  Google Scholar 

  40. Lane BR, Gill IS (2007) 5-Year outcomes of laparoscopic partial nephrectomy. J Urol 177:70–74

    Article  PubMed  Google Scholar 

  41. Link RE, Bhayani SB, Allaf ME, Varkarakis I, Inagaki T, Rogers C, Su LM, Jarrett TW, Kavoussi LR (2005) Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. J Urol 173:1690–1694

    Article  PubMed  Google Scholar 

  42. Bhayani SB, Snow DC (2008) Novel dynamic information integration during da Vinci robotic partial nephrectomy and radical nephrectomy. J Robotic Surg 2:67–69

    Article  Google Scholar 

  43. Caruso RP, Phillips CK, Kau E, Taneja SS, Stifelman MD (2006) Robot assisted laparoscopic partial nephrectomy: initial experience. J Urol 176:36–39

    Article  PubMed  Google Scholar 

  44. Ho H, Schwentner C, Neururer R, Steiner H, Bartsch G, Peschel R (2009) Robotic-assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year. BJU Int 103:663–668

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  46. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  47. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  PubMed  Google Scholar 

  48. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  49. Gong Y, Du C, Josephson DY, Wilson TG, Nelson R (2010) Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol 28:111–115

    Article  PubMed  CAS  Google Scholar 

  50. Mottrie A, De Naeyer G, Schatteman P, Carpentier P, Sangalli M, Ficarra V (2010) Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol 58:127–132

    Article  PubMed  Google Scholar 

  51. Scoll BJ, Uzzo RG, Chen DY, Boorjian SA, Kutikov A, Manley BJ, Viterbo R (2010) Robot-assisted partial nephrectomy: a large single-institutional experience. Urology 75:1328–1334

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Vascular Minimally Invasive and Robotic Surgery, San Matteo degli Infermi Hospital, Via Loreto 3, 06049, Spoleto PG, Italy

    Graziano Ceccarelli, Alberto Patriti, Alessia Biancafarina & Luciano Casciola

  2. Department of General Surgery “Pietro Valdoni”, Policlinico Umberto I, Università di Roma “La Sapienza”, Rome, Italy

    Massimo Codacci-Pisanelli

  3. Depatment of General Surgery and Organ Transplantation “Paride Stefanini”, Policlinico Umberto I, Università di Roma “La Sapienza”, Rome, Italy

    Cecilia Ceribelli

Authors
  1. Graziano Ceccarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Massimo Codacci-Pisanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alberto Patriti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cecilia Ceribelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessia Biancafarina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luciano Casciola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Graziano Ceccarelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ceccarelli, G., Codacci-Pisanelli, M., Patriti, A. et al. Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience. Updates Surg 65, 183–190 (2013). https://doi.org/10.1007/s13304-013-0209-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-013-0209-0

Keywords

Search

Navigation