Robot‐assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy

Abstract

Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robotassisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm 2 , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy will be more frequently carried out as a safe, effective and minimally-invasive nephronsparing surgery procedure.

Robot‐assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score‐matched comparative analysis of surgical outcomes and preserved renal parenchymal volume

“…The superiority of RAPN over LPN has previously been reported, and includes a clear, three‐dimensional view of the region of interest and fine movement of surgical instruments, with both of these factors likely contributing to the lower incidence of complications, such as open conversion, postoperative bleeding, urine leakage, shorter ischemia time and better preservation of renal function . In several reports, shortened WIT in RAPN has been associated with better preservation of renal function . The WIT in the present study was similarly shorter for the RAPN (17 min) than the LPN (25 min) procedure ( P < 0.0001), after propensity matching, suggesting that this difference in ischemia time might contribute to better renal function outcome in the RAPN than LPN group.…”

“…5,7,19,20 In several reports, shortened WIT in RAPN has been associated with better preservation of renal function. 7,16,21 The WIT in the present study was similarly shorter for the RAPN (17 min) than the LPN (25 min) procedure (P < 0.0001), after propensity matching, suggesting that this difference in ischemia time might contribute to better renal function outcome in the RAPN than LPN group.…”

“…With the refinement of techniques for robotic surgery, the indication for RAPN is increasingly expanding to include large and more complex tumors located in the renal hilum. 5, [15][16][17] We have preferentially adopted the RAPN technique in our institution since 2013, and the number of patients undergoing RAPN is also increasing in accordance with our experience. 18 In the present study, we showed that RAPN provided a better preservation of renal function and renal parenchymal volume than LPN, with similar surgical margin status and rate of perioperative complications for both techniques.…”

“…Consequently, RAPN has been increasingly used, as it facilitates forceps handling, which leads to precise resection and reconstruction for partial nephrectomy. With the refinement of techniques for robotic surgery, the indication for RAPN is increasingly expanding to include large and more complex tumors located in the renal hilum . We have preferentially adopted the RAPN technique in our institution since 2013, and the number of patients undergoing RAPN is also increasing in accordance with our experience .…”

Feasibility and necessity of the fourth arm of the da Vinci Si surgical system for robot‐assisted partial nephrectomy

“…Partial nephrectomy is the standard treatment for localized small renal masses due to equivalent oncological outcomes with the maximal preservation of renal function compared with radical nephrectomy . As a minimally invasive surgery, robot‐assisted partial nephrectomy (RAPN) is widely used for partial nephrectomy because it is technically less demanding with a shorter learning curve than laparoscopic partial nephrectomy . Furthermore, the diffusion of the da Vinci surgical system has an important role for the permeation of RAPN.…”