Robotic-assisted laparoscopic partial nephrectomy: initial clinical experience.

OBJECTIVES

To report on our initial experience with robotic-assisted partial nephrectomy. Laparoscopic partial nephrectomy requires experience and a lengthy learning curve to successfully accomplish tumor excision and renal reconstruction, which may adversely prolong the ischemia time. The advent of robotic-assisted laparoscopic surgery has proved successful in prostate cancer surgery, encouraging a growing number of centers to apply this technology to complex renal surgery.

METHODS

A total of 20 consecutive patients underwent robotic-assisted partial nephrectomy from September 2007 to April 2008. The surgical technique we used followed the standard 4-port laparoscopic partial nephrectomy technique. Renal hilum clamping was used in 12 cases. The demographic data and perioperative outcomes were retrospectively reviewed.

RESULTS

The mean patient age and body mass index was 66 years and 29 kg/m(2), respectively. The mean tumor size was 2.7 cm. The mean operative and warm ischemia time was 142 and 28 minutes, respectively. The mean estimated blood loss was 263 mL, and 3 patients required a blood transfusion. One intraoperative complication required open conversion. Two postoperative complications were observed; 1 patient developed a pulmonary embolism and 1 developed an abscess at the resection site. The average hospital stay was 2.8 days. Pathologic examination of the lesions revealed 14 cases of renal cell carcinoma and 6 of benign lesions. All resection margins were free of tumor.

CONCLUSIONS

The results of our study have shown that robotic partial nephrectomy is safe and practical for patients with small renal tumors considered candidates for open partial nephrectomy. In our experience, the procedure can be performed with safe ischemia time and offers all the advantages of a minimally invasive procedure.