Robotic Partial Nephrectomy: Results of First 62 Cases

Abstract

Introduction: Nephron sparing surgery is currently considered the gold standard of treatment for tumors smaller than 4 cm and in patients with a normal contralateral kidney. Open partial nephrectomy showed similar outcome, in complication rate and oncological outcome as radical nephrectomy. During the last decade, laparoscopic partial nephrectomy became a challenging procedure performed in many centers worldwide and requiring a long learning curve to reach acceptable warm ischemia times. For surgeons using the robotic system for radical prostatectomy, robot-assisted partial nephrectomy seemed a natural evolution of laparoscopy. We present a video of 7 min in which a robot-assisted partial nephrectomy is performed by Dr. Alexander Mottrie. The patient is a 53-year-old man with a posterior tumor of 3 cm diameter in the upper pole of the right kidney. Materials and Methods: We collected the data of the first 62 consecutive patients operated between September 2006 and November 2009. They all underwent a robot-assisted transperitoneal laparoscopic partial nephrectomy. All patients were operated by a single surgeon with the Da Vinci Si System. Data about clinical characteristics, perioperative data, complications, and postoperative functional outcome and pathology were collected. Results: The mean pathologic tumor size was 2.8 ± 1.3 cm. A pelvicaliceal repair was needed in 53% of cases. The mean console time was 91 ± 33 min with a mean warm ischemia time of 20 ± 7 min. Pathology results showed a positive surgical margin in 2%. Mean creatinine levels changed from a baseline value of 1.02 ± 0.38 to 1.1 ± 0.7 mg/dL 3 months after surgery. Estimated glomerular filtration rate (GFR) levels changed from a baseline value of 81.2 ± 29 to 80.5 ± 29 mL/min/1.73 m2 three months postoperatively. Conclusion: Robot-assisted laparoscopic partial nephrectomy is a feasible and technically possible alternative for open or laparoscopic partial nephrectomy. We believe that the Da Vinci system can facilitate the closure of the urinary collecting system and the reapproximation of the renal parenchyma, resulting in acceptable warm ischemia times. The authors (P. De Wil, V. Ficarra, G. De Naeyer, P. Schatteman, P. Carpentier, and A. Mottrie) have nothing to declare. No competing financial interests exist. Runtime of video: 7 mins