Robot-assisted Laparoscopic Partial Nephrectomy

PURPOSE: Laparoscopic partial nephrectomy is a treatment option for small renal masses. However, such time-consuming techniques such as tumor excision, hemostasis and intracoporeal suturing are still challenging procedures even for experienced laparoscopists. Incorporation of a robotic system would facilitate tumor excision, hemostasis and intracoporeal suturing. Herein, we review our technique and the short term outcomes for robot-assisted laparoscopic partial nephrectomy(RLPN). MATERIALS and METHODS: Eleven patients underwent RLPN for small renal masses. RLPN were performed with the da Vinci(R) robot system(Intuitive Surgical, Sunnyvale, USA) with three robot arms. In 7 cases, the renal hilum was clamped. Tumor excision and intracorporeal suturing were performed entirely with the robotic system. The specimen was extracted through the extended umbilical port incision. RESULTS: The mean tumor diameter was 2.5+/-1.5cm. The mean operative time was 179.5+/-49.4 minutes and the mean estimated blood loss was 354.5+/-440.7ml. The mean warm ischemia time was 30.4+/-5.9 minutes for 7 patients. There were no major complications. The surgical pathology showed clear cell type renal cell carcinoma in 7, papillary type renal cell carcinoma in 1, angiomyolipoma in 2 and lipoma in 1. There were no positive surgical margins. The mean hospital stay was 4.2+/-1.3 days. No recurrence had been observed after 3 to 18 months of follow-up. CONCLUSIONS: We were able to verify the feasibility and safety of using a RLPN in the management of small renal masses. Longer follow-up data and larger prospective studies are necessary to confirm these results.ope