Abstract
BackgroundWith the establishment of minimally invasive surgery in society, the robot has been increasingly widely used in the urologic field, including in partial nephrectomy. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of >4 cm.Method and FindingsAn electronic database search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed. This systematic review and meta-analysis was based on all relevant studies that assessed robotic partial nephrectomy for renal tumors of >4 cm. Five studies were included. The meta-analysis involved 3 studies from 11 institutions including 154 patients, while the narrative review involved the remaining 2 studies from 5 institutions including 64 patients. In the meta-analysis, the mean ischemic time, operation time, and console time was 28, 319, and 189 minutes, respectively. The estimated blood loss and length of stay was 317 ml and 3.8 days, respectively. The rates of conversion, positive margins, intraoperative complications, postoperative complications, hilar clamping, and collecting system repair were 7.0%, 3.5%, 7.0%, 9.8%, 93.9%, and 47.5%, respectively. The narrative review showed results similar to those of the meta-analysis.ConclusionsRobotic partial nephrectomy is feasible and safe for renal tumors of >4 cm with an acceptable warm ischemic time, positive margin rate, conversion rate, complication rate, operation time, estimated blood loss, and length of stay.
Highlights
Partial nephrectomy (PN) is the gold standard for treatment of small renal masses and selected T1b tumors for which removal is technically feasible [1]
Evolution has progressed from open radical nephrectomy (RN) through open PN to minimally invasive PN, including laparoscopic PN (LPN) and robotic PN (RPN) [2]
RPN provides benefits similar to those provided by LPN with acceptable safety [3,4]
Summary
Partial nephrectomy (PN) is the gold standard for treatment of small renal masses and selected T1b tumors for which removal is technically feasible [1]. Evolution has progressed from open radical nephrectomy (RN) through open PN to minimally invasive PN, including laparoscopic PN (LPN) and robotic PN (RPN) [2]. RPN provides benefits similar to those provided by LPN with acceptable safety [3,4]. PN for larger tumors (.4 cm) is reportedly similar to RN by a laparoscopic approach in terms of oncologic and functional outcomes [5,6], providing evidence of the feasibility of this minimally invasive procedure. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of .4 cm
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