910 ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR TUMORS GREATER THAN 4 CM: FEASIBILITY AND EARLY FUNCTIONAL OUTCOMES

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010910 ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR TUMORS GREATER THAN 4 CM: FEASIBILITY AND EARLY FUNCTIONAL OUTCOMES Paul H. Chung, Gopal Gupta, Ronald S. Boris, W. Marston Linehan, Peter A. Pinto, and Gennady Bratslavsky Paul H. ChungPaul H. Chung More articles by this author , Gopal GuptaGopal Gupta More articles by this author , Ronald S. BorisRonald S. Boris More articles by this author , W. Marston LinehanW. Marston Linehan More articles by this author , Peter A. PintoPeter A. Pinto More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1666AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The oncologic efficacy and preservation of renal function has been well established for nephron sparing surgery (NSS) with T1b tumors. Robot assisted laparoscopic partial nephrectomy (RALPN) has emerged offering benefits of earlier convalescence similar to traditional laparoscopy. Initially introduced to excise small exophytic tumors, RALPN has recently evolved to allow treatment of more complex renal masses. We report on the technical feasibility and early functional outcomes of RALPN for tumors greater than 4 cm. METHODS Between 2007 and 2009, we identified 19 RALPN in 17 patients (10 with and 7 without known hereditary syndromes) treated at our institution for solid tumors greater than 4 cm. Demographic, operative, and pathologic data were collected. Renal function was assessed by serum creatinine levels, estimated glomerular filtration rate (GFR) and nuclear renal scans assessed at baseline and 3 months post-operatively. All tumors were assigned a R.E.N.A.L. nephrometry score (www.nephrometry.com). RESULTS Patient, tumor and intraoperative data are listed in Table 1.x Three of 19 cases (16%) required intraoperative conversion. No renal units were lost. Average R.E.N.A.L. nephrometry score for the largest tumor from each kidney was 8.9 (range 6-11), while the average size was 6.1 cm (range 4.1 to 15). One patient developed ureteropelvic junction obstruction requiring subsequent stenting. There were no statistically significant differences between preoperative and postoperative creatinine (0.9 mg/dL vs. 1.0 mg/dL, p=0.12) or eGFR (87.6 mg/dL vs. 88.7 mg/dL, p= 0.81). However, there was a statistically significant decline of ipsilateral renal scan function (49.9% vs. 44.5%, p=0.002) at three months. No patients had evidence of recurrent disease or metastatic disease at a mean follow up of 10 months (range 1-25). Patient Data Operation # / Patient # 19/17 Age, yrs (range) 46(26to71) Mean BMI (range) 28.5(19.8to40.4) Male (%) 9(53) Surgery on the right, # (%) 11(58) Hereditary Disease, # (%) 10(59) Tumor Data Mean Tumor per patient, # (range) 1.6(1to4) Tumor Histology, # (%) Clear Cell 11(58) Papillary Type 1 4(21) Chromophobe 2(11) Oncocytoma 1(5) Angiomyolipoma 1(5) Operative Data Operative Time, min (range) 317(220to496) Warm Ischemia Time, min (range) 35.6(11to61) Estimated Blood Loss, mL (range) 659.4(100to1600) CONCLUSIONS RALPN is feasible for renal tumors greater than 4 cm and higher nephrometry scores. Although there was a modest decline in renal function of the operated unit, RALPN affords the ability to resect challenging tumors that require complex renal reconstruction. Longer follow up will be needed to further assess functional and oncologic outcomes. Bethesda, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e355 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul H. Chung More articles by this author Gopal Gupta More articles by this author Ronald S. Boris More articles by this author W. Marston Linehan More articles by this author Peter A. Pinto More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...