Current Status of Robot-Assisted Laparoscopic Partial Nephrectomy

Abstract

With increased incidence of diagnosis of small renal masses, partial nephrectomy has been preferred over radical nephrectomy as the surgical treatment of choice. The transition from open to laparoscopic partial nephrectomy had been challenging for many urologists. Robotic-assisted laparoscopic partial nephrectomy(RLPN) is increasingly used to facilitate this transition . In this review, we examine the recent technical advances and clinical outcomes in RLPN. Many series had successfully reported the feasibility of using the da Vinci Surgical (Intuitive Surgical Inc, Sunnyvale, CA) System in laparoscopic partial nephrectomy. Recent advances had focused on reducing risk of renal damage by shortening the warm ischaemia time. These techniques included unclamped excision, selective arterial clamping and improved renorrhaphy methods. Operative times and warm ischaemia times have also improved once the learning curve are overcome, which is less steep than conventional laparoscopy. With longer follow-up and more widespread experience, the outcome of RLPN could be favourable compared to conventional laparoscopy. Improving techniques had made this surgery a safe and efficacious treatment option for small renal masses.

Anesthetic considerations for robotic surgery

“…Regarding radical nephrectomy, robot-assisted surgery failed to show any advantage compared with the laparoscopic method. However, in partial nephrectomy, it is thought to have advantages over the laparoscopic method [ 7 ]. Robot-assisted partial nephrectomy (RAPN) was associated with a significant reduction in blood loss and surgical complications, and with a shorter duration of hospitalization [ 8 ].…”

“…Robot-assisted partial nephrectomy (RAPN) was associated with a significant reduction in blood loss and surgical complications, and with a shorter duration of hospitalization [ 8 ]. Moreover, it has been used to reduce the risk of renal damage by shortening the "warm ischemic time" [ 7 ]. To reduce the warm ischemic time, early unclamping, no vascular clamping, selective renal parenchymal clamping, and selective arterial clamping have been attempted; these are difficult to perform in laparoscopic surgery [ 7 ].…”

“…Moreover, it has been used to reduce the risk of renal damage by shortening the "warm ischemic time" [ 7 ]. To reduce the warm ischemic time, early unclamping, no vascular clamping, selective renal parenchymal clamping, and selective arterial clamping have been attempted; these are difficult to perform in laparoscopic surgery [ 7 ]. Compared with RALRP, a wider surgical field is required, and clashes between the robotic arms can be problematic.…”

Bloqueos de pared abdominal en nefrectomía parcial asistida por robot

“…Si bien, la superioridad de la cirugía robótica por sobre la laparoscópica en nefrectomía radical no ha sido del todo esclarecida, la nefrectomía parcial asistida por robot ha mostrado una reducción significativa en pérdidas sanguíneas, duración de la estadía hospitalaria y complicaciones quirúrgicas (i.e. daño renal por isquemia) [8], [9].…”