Abstract

BackgroundLaparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN.MethodsA Medline search was performed between 2000–2013 with the terms “robotic radical nephrectomy”, “robot-assisted laparoscopic nephrectomy”, “radical nephrectomy”. Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified.ResultsCurrent literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100–273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS.ConclusionsNo advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist.

Highlights

  • Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC)

  • The comparative studies between robotic radical nephrectomy (RRN) and LRN [15,16,17] showed no differences in the evaluated outcomes except for a longer operative time (OT) for the robotic approach as evidenced in two studies [15,17]

  • Current literature does not provide any advantage for RRN if compared to standard laparoscopy; RRN seems rather a “technical overtreatment”

Read more

Summary

Introduction

Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN. Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized RCC (cT1-2 with no indications for nephron-sparing surgery) [2]. The first robotic radical nephrectomy (RRN) for RCC was described by Klingler et al [3] in 2000. Only feasibility studies of simple robotic nephrectomy on the suine model [4], one robotic nephrectomy on human for a case of a nonfunctioning hydronephrotic kidney -owing to a ureteropelvic junction obstruction- [5] and 11 robotic live-donor nephrectomies [6,7] were published, with promising results

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call