Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Abstract

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

Robot-assisted partial nephrectomy: Excellent results even in more complex renal tumours

“…10 Furthermore, the simultaneous presence of negative margins, minimal decreases in eGFR and no urological complications, defined as the trifecta rate, 11 was achieved in 56.9% of cases. 7 This result seems quite lower than the value (68%) reported by Hung and colleagues. 11 They used a larger cohort of robotic/laparoscopic partial nephrectomies performed at a high-volume centre by a single experienced surgeon.…”

“…6 Ploussard and colleagues recently reported an interesting single-institution Canadian experience of 65 consecutive RAPNs performed between 2011 and 2013 by 2 surgeons with prior experience in robot-assisted radical prostatectomy or pure laparoscopic partial nephrectomy. 7 The mean tumour size was 3.9 cm and, remarkably, 47.7% of those masses were >4 cm in maximum diameter. The tumour complexity was evaluated by the R.E.N.A.L.…”

Prospective study of robotic partial nephrectomy for renal cancer in Japan: Comparison with a historical control undergoing laparoscopic partial nephrectomy

“…10,19 Additionally, we used kidney scintigraphy, 180 days preand postoperatively, to evaluate the function of the operated kidneys. The change in eGFR, 1 year postoperatively, was approximately 10%, which was similar to that in previous reports.…”

Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 42 cases

“…Robotic surgery has the advantages of removing tremor, providing surgeons with enhanced capabilities including a three‐dimensional, magnified view, and fulfills the requirements of effective laparoscopic surgery. In the literature, the number of studies including RAPN series has increased in recent years [12–18]. In the early studies, the results of initial experiences were reported; however, now the results of quite extensive series comparing robotic procedure with laparoscopic PN and open surgery are being published.…”