Robotic Nephrectomy for Complex Tumors

Abstract

Robotic surgery has been applied for increasingly complex procedures. Nephrectomy has traditionally been considered a less complicated procedure in the hands of experienced laparoscopic surgeons, with many feeling that robotic technology is not necessary for this operation. Changes occurring in the field of urology will likely make robotic nephrectomy an important procedure. Partial nephrectomy is gaining acceptance in the urologic community as a preferable treatment for renal tumors such that radical nephrectomy for small renal masses will likely become a rarity. This evolution means that radical nephrectomy will be a procedure applied only to larger and more complex tumors that would not be amenable to partial nephrectomy even with open surgery. Still, some of these can be treated laparoscopically, but robotic surgery provides an additional level of precision and control for such complex tumors. Furthermore, as surgeons gain experience and expertise in robotic surgery, techniques have been developed to allow robotic nephrectomy for tumors traditionally felt impossible to treat laparoscopically. Examples of such situations, both those benefitting from robotic instrumentation due to the complexity of the renal tumor and situations not previously able to be performed laparoscopically, are reviewed in this chapter.