Robotic partial nephrectomy: The new horizon

Abstract

BackgroundThere has been an exponential growth in the reporting of series of robotic partial nephrectomy (RPN). We review the technique of RPN and the outcomes from large single-centre series of RPN.MethodsWe searched databases to identify original articles related to RPN. For the technical aspects, we describe our technique and provide a general review of previous work. For outcomes, we reviewed previous reports using more rigid criteria, including only single-institution studies with at least 50 patients undergoing RPN.ResultsWe found seven retrospective studies that met our criteria, with a total of 701 patients. Mean tumour size was 2.8 cm, with an average R.E.N.A.L. score (Radius, tumour size as maximum diameter; Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior, a/posterior, p, descriptor, and the Location relative to the polar line) of 6.8. The mean warm ischaemia time was 21 min and mean operative duration was 196 min. The mean estimated blood loss was 182 mL, with a 7.4% transfusion rate. The conversion rate was 1.7% and the postoperative complication rate was 14%. The mean length of stay was 3.6 days. There were positive surgical margins in 1.7% of patients. The mean decrease in renal function was 5.4% and the mean follow-up was 8.4 months.ConclusionsRPN is feasible and safe for different levels of complexity of renal tumours. Perioperative outcomes are comparable to those found with more established techniques. Future studies should compare different approaches and prioritise prospective and randomised designs.

Robotic partial nephrectomy: Current technique and outcomes

“…Laydner et al . reviewed retrospective studies of a relatively large RAPN series . The mean EBL of RAPN was 182 mL, with a 7.4% transfusion rate.…”

“…Laydner et al . reviewed 701 cases and showed a total of 93 postoperative complications, 69% were related to non‐urological complications causes . Most of the complications (73%) were grade 1 and 2 according to Clavien classification.…”

“…A survey on the use of LPN in 855 patients in 17 centers in the USA and Europe showed a PSM rate of 2.4% . PSM was found in 1.7% of the cases, with a mean follow up of 8.4 months in a review of 701 RAPN cases . Benway et al .…”

“…In 2008, RAPN was the fastest growing robotic procedure worldwide among any surgical specialty . A systematic review, which included >700 patients who underwent RAPN, showed that RAPN was feasible and had similar results to laparoscopic and open techniques …”

“…19 A systematic review, which included >700 patients who underwent RAPN, showed that RAPN was feasible and had similar results to laparoscopic and open techniques. 20 In the present review, we introduce our surgical steps of RAPN, including operative principle and technologies. We also review the literature for intermediate perioperative and oncological outcomes.…”