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Scoll BJ , Uzzo RG , Chen DYT , Boorjian SA , Kutikov A , Manley BJ , Viterbo R
Robot-assisted Partial Nephrectomy: A Large Single-institutional Experience
Urology. 2010 Jun;75(6) :1328-1334
PMID: ISI:000278221100026   
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Abstract
OBJECTIVES To report experience with 100 robot-assisted partial nephrectomy (RAPN) operations performed at our institution. Nephron-sparing surgery is an established treatment for patients with small renal masses. The laparoscopic approach has emerged as an alternative to open nephron-sparing surgery, but it is recognized to be technically challenging. The robotic surgical system may enable faster and greater technical proficiency, facilitating a minimally invasive approach to more difficult lesions while reducing ischemia time. METHODS A total of 100 RAPN operations were performed for suspicious solid renal lesions during a 21-month period. Clinicopathologic variables, nephrometry scores, operative parameters, and renal functional outcomes were prospectively recorded and analyzed. RESULTS Median tumor size was 2.8 cm (range, 1.0-8). Nephrometry scores of resected lesions were low in 47.9% of patients, medium in 45.7%, and high in 6.4% of patients. Forty-seven percent of patients had tumors >50% intraparenchymal, and 61.7% had tumors located less than 7 mm away from the renal sinus or collecting system. In 17% of patients, the tumors were touching a first-order vessel in the renal hilum. Mean warm ischemia time was 25.5 minutes (range, 0-53). Mean change in postoperative glomerular filtration rate improved 6.32 mL/min/1.73 m(2) (range, -41.9 to 68.9). Histology was renal cell carcinoma in 81% (87/107) of tumors. There were 5 microscopically positive margins on final pathology (5.7%). Major and minor complication rates were 6% and 5%, respectively. There were 2 conversions to open surgery. CONCLUSIONS RAPN seems to be a safe and technically feasible minimally invasive approach to nephron-sparing surgery even in more complex cases, with acceptable pathologic and renal function outcomes. UROLOGY 75: 1328-1334, 2010. (C) 2010 Elsevier Inc.
Notes
Scoll, Benjamin J. Uzzo, Robert G. Chen, David Y. T. Boorjian, Stephen A. Kutikov, Alexander Manley, Brandon J. Viterbo, Rosalia National Cancer Institute [P30 CA006927]; Fox Chase Cancer Center This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute. Additional funds were provided by Fox Chase Cancer Center via institutional support of the Kidney Cancer Keystone Program. 26 Elsevier science inc; 360 park ave south, new york, ny 10010-1710 usa 603ps