Abstract
ABSTRACTObjectivesThe aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy).Materials and methodsFrom September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded.ResultsAll of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7).ConclusionsThe retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
Highlights
ORN (Open Radical Nephrectomy) has been for years the gold standard for the treatment of all renal masses including low-staged tumors
The majority of the existing literature on robotic-assisted partial nephrectomy (RAPN) describe transperitoneal approach and only few papers are published on retroperitoneal RAPN
Based on our experience with laparoscopic retroperitoneal approach, we recognized that the retroperitoneal approach combines the advantages of robotic technology (3D visualization, increased degrees of freedom of movements) with the advantages of retroperitoneal approach which includes advantages of direct access to the renal hilum and reduced lesion risk to abdominal organs, earlier return of bowel function and shorter length of hospital stay
Summary
ORN (Open Radical Nephrectomy) has been for years the gold standard for the treatment of all renal masses including low-staged tumors. The LRN (Laparoscopic Radical Nephrectomy) first described by Clayman et al in 1991 [1] is widely used because of the advantages of reduced operative and postoperative morbidity with the same short and long-term oncologic efficacy comparing with open technique Despite this the understanding of increased risk of CKD (Chronic Kidney Disease) has led to try to preserve as much normal renal parenchyma as possible, the use of nephron-sparing surgery is the recommended surgical treatment for T1 tumors [2]. This article presents the series of a single center experienced in open, laparoscopic and robotic-assisted partial nephrectomy
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