Initial experience of robot‐assisted radical nephrectomy in Japan: Single institutional study of 12 cases

Abstract

Introduction To evaluate the initial experience of robot‐assisted radical nephrectomy (RARN) in a single institution in Japan. Methods This study included a total of 12 patients with renal tumors who were not preoperatively regarded as optimal candidates for robot‐assisted partial nephrectomy (RAPN) and subsequently treated with RARN between April 2019 and June 2021 at our institution. Comprehensive perioperative outcomes in these patients were retrospectively analyzed. Results Of the 12 included patients, 10 and two were male and female, respectively, and the median age was 66 years. The median tumor diameter was 44 mm, and four, four and four patients were classified into cT1a, cT1b and cT3a, respectively. There was no patient requiring open conversion, and the median operative and console times were 167 and 79 minutes, respectively. The median estimated blood loss was 42 cc, and no patient required blood transfusion. During the perioperative period, no major complication corresponding to Clavien‐Dindo grade ≥3 occurred. Nine, two and one patient were pathologically diagnosed with clear cell carcinoma (CCC), non‐CCC and benign cyst, respectively, and there was no patient who developed recurrent diseases. Conclusions Considering complicated tumor characteristics not amenable to RAPN in this series, such as an intravenous tumor thrombus or previous history of open partial nephrectomy, perioperative outcomes of initial experience with RARN in Japan could be considered favorable. Collectively, these findings suggest that RARN may be a promising alternative to laparoscopic radical nephrectomy for patients with complicated renal tumors, contraindicated for RAPN.

Robot‐assisted radical nephrectomy and inferior vena cava tumor thrombectomy: Initial experience in Japan

“…After IVCTT was completed, right RN combined with an en bloc removal of the right adrenal gland was conducted. 8 The console time, total operative time, and estimated blood loss were 167 min, 211 min, and 150 mL, respectively, and no significant complication was noted during or after RA-RN/IVCTT. Five days after the operation, this patient was discharged.…”

“…More recently, therefore, a robotic approach has been expanded to RCC with a high‐level IVC tumor thrombus by a few teams with sufficient experience of robotic surgery 9,10 . In Japan, RA‐RT/IVCTT has not been performed, because RARN has yet to be approved; however, we have conducted RARN after the approval by the research ethics committee 8 . Based on this experience, we firstly applied a purely robotic approach to the treatment of a patient diagnosed with RCC with an IVC thrombus in Japan.…”

“…Considering her favorable general condition, RA‐RN/IVCTT was scheduled to be performed. As described previously, we have started RARN after the approval by the research ethics committee of our hospital (Certificate number: 21‐091), 8 and written informed consent by this patient to receive RARN was obtained.…”

“…The proximal end of IVC, the distal end of IVC, and the left renal vein were sequentially released to restore caval flow. After IVCTT was completed, right RN combined with an en bloc removal of the right adrenal gland was conducted 8 …”

“…The patient's position and placement of trocars were same as those in our previous report. 8 After the robotic system was docked, under the cephalic retraction of the liver, the right colon and duodenum were medially reflected, and the surfaces of bilateral renal veins and IVC were exposed. To circumferentially dissect IVC above and below the renal hilum, all feeding veins were divided after clipping.…”