You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology III1 Apr 2016MP34-15 ZERO ISCHEMIA PERI-TUMORAL RADIOFREQUENCY ABLATION-ASSISTED ROBOTIC LAPAROSCOPIC PARTIAL NEPHRECTOMY – AN UPDATE ON INTERMEDIATE OUTCOMES IN 49 PATIENTS Kalen Rimar and Robert Nadler Kalen RimarKalen Rimar More articles by this author and Robert NadlerRobert Nadler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1573AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy with peri-tumoral radiofrequency ablation (RF-RPN) is a novel clampless technique which attempts to eliminate the risks of hemorrhage and warm ischemia associated with laparoscopic partial nephrectomy (LPN). We describe our cumulative experience. METHODS From May, 2007 to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RF-RPN. During this period, only the RF-RPN technique was utilized for all cases of LPN. Laparoscopic ultrasonography was performed to locate the tumor. The da Vinci® robot (Intuitive Surgical, Sunnyvale, CA) and Habib® 4X bipolar RFA device (AngioDynamics, Queensbury, NY) coupled to the Rita 1500X (software v.8.41) generator were used to create a 0.5 cm plane of coagulated tissue at the interface between the tumor and normal parenchyma. The robotic cold scissors were used to excise the tumor. The RFA device was used to control any bleeding as needed. We recorded the total amount of time the RFA energy was applied. Pre- and post-operative data including renal function, complications and oncologic outcomes were analyzed in 49 consecutive patients with 4.5 (mean) years follow up (tables 1-4) and compared to 36 consecutive patients who underwent LPN with renal hilar vessel clamping and cold sharp excision of renal tumors from October 2002 to May 2007. RESULTS In total, 49 tumors were treated. Mean tumor size was 2.6 cm. 57.1% were endophytic. Mean cumulative time RFA energy used was 25.5 minutes. 17 (34.7%) patients had a post-operative urine leak and were more likely to have required collecting system repair (95.1 vs. 65.6%, p=.021), higher American Society of Anesthesiology (ASA) scores =3 (35.3 vs. 18.8%, p<.001) and longer duration of RFA (30.7 vs. 22.3 minutes, p=.087). Blood transfusion was required in 8% of patients. Over a mean follow up of 4.5 years, there was a significant decrease in the glomerular filtration rate (GFR) of 18% (80.7 vs. 65.9, p<0.001, mean -14.8 mL/min/1.73m2). There was a significant decrease in the GFR of the comparison group of 19.7% (83.9 vs. 67.4, p<0.001, mean -16.5 mL/min/1.73m2). There was no significant difference between the two groups regarding change in GFR (p = 0.67). In the RF-RPN group 2 patients (4.1%) had local recurrence and 1 had metastatic recurrence. There were no recurrences in the comparison group. CONCLUSIONS Our data suggests that this technique is associated with a similar degree of deterioration in renal function, but possibly higher rates of blood transfusion, post-operative urine leak, and recurrence when compared to our series of consecutive laparoscopic partial nephrectomy as well as large historical series of laparoscopic and open partial nephrectomy for renal masses <7 cm. Future investigation with newer RFA probes allowing for more focused energy delivery may be warranted. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e477 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kalen Rimar More articles by this author Robert Nadler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...