Is Robotic-assisted partial nephrectomy an efficacious and safe procedure for removal of stage T1 renal tumors?

Abstract

Background Robotic surgery has now evolved as an emerging tool for better and easy operative techniques. The quest for trifecta comprising warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications seems to be better accomplished by robotic partial nephrectomy, which is likely to become the new standard for minimally invasive partial nephrectomy. Materials & Methods It is a prospective observational study over 18 months in patients aged more > 18 years with a renal tumour of clinical stage T1 coming for robotic partial nephrectomy. A total of 40 patients were included in the study who underwent robotic-assisted partial nephrectomy for renal tumours less than 7 cm in size. The duration of the study was from July- 2018 to December-2019 and their follow up period was 3 months post-surgery. Results Of the 40 patients, the mean age was 52.3 ± 11.91 years. 28 (70%) patients were males and remaining 12 (30%) were females. 11 (27.5%) tumours were situated in the anterior upper pole, 9 (22.5%) in the anterior lower pole, 8 (20%) in the posterior upper pole, 7 (17.5%) in the posterior lower pole and interpolar tumours were 5 in number (12.5%). 24 (60%) tumors were ≥ 50% exophytic, 11 (27.5%) were < 50% exophytic and 5 (12.5%) were purely endophytic in nature. Maximum nephrometry score was 5a amounting to 10 (25%) patients and 5p tumours were the second most common amounting to 7 (17.5%) patients. The mean console time was noted to be 84.40± 12.05 mins. The mean total operative time was noted to be 167.00 ± 21.116 minutes. Mean Warm Ischemia Time (WIT) was recorded to be 27.28 ± 5.923 minutes. The mean blood loss was 145.75±61.075 ml. The mean length of hospital stay was 4.27 ± 0.78 days. None of the cases was converted to open partial/radical nephrectomy and none had positive surgical margins in the histopathology reports. Conclusion Our study shows that Robotic Assisted Partial Nephrectomy (RAPN) is an efficacious and safe surgery in stage T1 renal tumours (tumour size <7 cm) to achieve complete oncological clearance by minimal access technique.