Abstract
Objectives
Laparoscopic partial nephrectomy (LPN) remains challenging to even experienced laparoscopists. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery (NSS). We represented our technique and results of robotic partial nephrectomy (RPN) for hilar, endophytic, and multiple renal tumors.
Materials and methods
Between May 2006 and March 2008, 29 patients with complex renal tumors underwent RPN, including hilar (n = 14), endophytic (n = 12) and multiple tumors (n = 3).The hilar vessels were clamped with laparoscopic bulldog with warm ischemia. Follow-up ranged from 3 to 23 months (mean of 15 mo). The perioperative data and pathologic results were retrospectively reviewed.
Results
Robotic partial nephrectomy procedures were performed successfully without complications. The mean diameter of tumors was 3.0 cm (range 2.0–4.0). The mean operative time was 197 minutes (range 172–259), and the mean blood loss was 220 ml (range 100–370). The mean warm ischemia time (WIT) was 25 min (range 16–43). The hospital stay averaged 2.5 days (range 2–3). Histopathology confirmed clear-cell carcinoma (n = 21), chromophobe cell carcinoma (n = 4), hybrid oncocytic tumor (n = 2), oncocytoma (n = 1), and cystic renal cell carcinoma (n = 1). All cases had negative surgical margins. At the 3–23 months (mean of 15 mo) follow-up, no patients experienced a significant change of glomerular filtration rate compared to preoperative levels and there was no evidence of tumor recurrence.
Conclusion
Robotic partial nephrectomy is a safe and feasible procedure. RPN is a preferred approach for complex renal tumors when NSS is indicated. For complex and technical challenging renal tumors, robotic assistance may provide patients the benefit of minimally invasive surgery.
Similar content being viewed by others
References
Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46. doi:10.1016/j.juro.2007.03.038
Erik S, Weise MD, Howard N (2005) Laparoscopic partial nephrectomy. J Endourol 19(6):634–642. doi:10.1089/end.2005.19.634
Phillips CK, Taneja SS, Stifelman MD (2005) Robot-assisted laparoscopic partial nephrectomy: the NYU technique. J Endourol 19:441–445. doi:10.1089/end.2005.19.441 (discussion 445)
Kaul S, Laungani R, Sarle R et al (2007) Da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Eur Urol 51:186–192. doi:10.1016/j.eururo.2006.06.002
Laura EC, Rebecca AN et al (2008) Multi-institutional study of symptomatic deep venous thrombosis pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 53:134–145
Jim CH, Timothy GW, Mark HK et al (2005) Perioperative complications of laparoscopic and robotic assisted laparoscopic radical rostatectomy. J Urol 175:541–546
Laura EC, Timothy GW, Rebecca AN et al (2008) Can robotic assisted laparoscopic prostatectomy be recommended to obese patients? J Robotic Surg 1:297–302
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. doi:10.1016/j.urology.2004.06.049
Caruso RP, Phillips CK, Kau E, Taneja SS, Stifelman MD (2006) Robot-assisted laparoscopic partial nephrectomy: initial experience. J Urol 176(1):36–39. doi:10.1016/S0022-5347(06)00499-X
Craig GR, Amar S, Adam MB et al (2008) Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 53:514–523
Thompson T, Ng CF, Tolley D (2003) Renal parenchymal hemostatic aids: glues and things. Curr Opin Urol 13:209–214. doi:10.1097/00042307-200305000-00007
Leslie AD, Hak JL, Geoffrey NB et al (2008) Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. J Endourol 22(5):947–952. doi:10.1089/end.2007.0376
Conflict of interest statement
The authors have nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gong, Y., Du, C., Josephson, D.Y. et al. Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol 28, 111–115 (2010). https://doi.org/10.1007/s00345-009-0427-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-009-0427-8