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Four-arm robotic partial nephrectomy for complex renal cell carcinoma

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Abstract

Objectives

Laparoscopic partial nephrectomy (LPN) remains challenging to even experienced laparoscopists. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery (NSS). We represented our technique and results of robotic partial nephrectomy (RPN) for hilar, endophytic, and multiple renal tumors.

Materials and methods

Between May 2006 and March 2008, 29 patients with complex renal tumors underwent RPN, including hilar (n = 14), endophytic (n = 12) and multiple tumors (n = 3).The hilar vessels were clamped with laparoscopic bulldog with warm ischemia. Follow-up ranged from 3 to 23 months (mean of 15 mo). The perioperative data and pathologic results were retrospectively reviewed.

Results

Robotic partial nephrectomy procedures were performed successfully without complications. The mean diameter of tumors was 3.0 cm (range 2.0–4.0). The mean operative time was 197 minutes (range 172–259), and the mean blood loss was 220 ml (range 100–370). The mean warm ischemia time (WIT) was 25 min (range 16–43). The hospital stay averaged 2.5 days (range 2–3). Histopathology confirmed clear-cell carcinoma (n = 21), chromophobe cell carcinoma (n = 4), hybrid oncocytic tumor (n = 2), oncocytoma (n = 1), and cystic renal cell carcinoma (n = 1). All cases had negative surgical margins. At the 3–23 months (mean of 15 mo) follow-up, no patients experienced a significant change of glomerular filtration rate compared to preoperative levels and there was no evidence of tumor recurrence.

Conclusion

Robotic partial nephrectomy is a safe and feasible procedure. RPN is a preferred approach for complex renal tumors when NSS is indicated. For complex and technical challenging renal tumors, robotic assistance may provide patients the benefit of minimally invasive surgery.

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Conflict of interest statement

The authors have nothing to disclose.

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Authors and Affiliations

  1. Department of Urology, Second Affiliated Hospital, Zhejiang University College of Medicine, 310009, Hangzhou, Zhejiang, China

    Yu Gong & Chuanjun Du

  2. Department of Urology and Urologic Oncology, City of Hope, National Medical Center, Duarte, Los Angeles, CA, 91010, USA

    David Y. Josephson & Timothy G. Wilson

  3. Department of Biostatics, City of Hope, National Medical Center, Duarte, Los Angeles, CA, 91010, USA

    Rebecca Nelson

Authors
  1. Yu Gong
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  2. Chuanjun Du
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  3. David Y. Josephson
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  4. Timothy G. Wilson
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  5. Rebecca Nelson
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Corresponding author

Correspondence to Yu Gong.

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Gong, Y., Du, C., Josephson, D.Y. et al. Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol 28, 111–115 (2010). https://doi.org/10.1007/s00345-009-0427-8

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  • DOI: https://doi.org/10.1007/s00345-009-0427-8

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