Optimization of renal function preservation during robotic partial nephrectomy

Abstract

Over the past few years, the role of robotic-assisted partial nephrectomy (RPN) has exponentially grown. Multiple recognized factors contribute to postoperative renal function in patients undergoing RPN. The aim of this review is to identify these potential factors, and to evaluate strategies that may help optimize the goal of renal function preservation. A nonsystematic literature review was performed to retrieve the most recent evidence on factors contributing to renal function post-RPN. Analyzed elements include baseline factors (tumor complexity and patient characteristics), intraoperative (surgical) factors (control of the renal hilum and type of ischemia, resection technique, renorrhaphy technique), and pharmacotherapeutics. In conclusion, the advantages of robotic surgery in the setting of partial nephrectomy (PN) are becoming well established. Maximal preservation of renal function remains a priority goal of the procedure, and it is influenced by a plethora of factors. Adequate patient selection using radiomics, control of comorbidities, utilization of evidence-based intraoperative techniques/strategies, and postoperative care are key components of postoperative preservation of renal function. Further investigations regarding these factors and their effects on long-term renal function are necessary and will continue to aid in guiding appropriate patient care.

Three-dimensional Reconstruction of Renal Vascular Tumor Anatomy to Facilitate Accurate Preoperative Planning of Partial Nephrectomy

“…The maximal preservation of renal function remains a priority in performing a partial nephrectomy, and such preservation is influenced by several factors, including case selection, preoperative renal function, surgical technique, and the volume of healthy renal parenchyma [ 21 – 23 ]. Wang et al previously reported that a 3D reconstruction technique allowed for the accurate reconstruction of the relevant anatomical structures and presented the tiny vessels and tissues around a tumor, such that the technique proved to be a beneficial method in terms of preserving more parenchymal mass and postoperative ipsilateral GFR [ 17 ].…”