Laparoscopy and RoboticsOutcomes of Robotic Nephrectomy Including Highest-complexity Cases: Largest Series to Date and Literature Review
Section snippets
Methods
A prospective database of 101 consecutive nephrectomies by a single surgeon (R.A.) between 2008 and October 2012 was reviewed with institutional review board approval. All patients underwent RALN regardless of complexity, although the patients were consented for possible open conversion if necessary. This experience began after performing several hundred robotic procedures, after which the surgeon began performing only RALN rather than ORN or LN regardless of complexity. All consecutive RALNs
Results
Mean patient age was 60 years (19-86 years) as per Supplementary Table 1. Mean patient body mass index (BMI) was 31 kg/m2 (16-54 kg/m2), including 38 patients of BMI 30-39 kg/m2 and 14 patients of BMI >40 kg/m2. RALN was performed for tumors in 90 patients with the remaining performed for benign conditions such as recurrent pyelonephritis and/or chronic obstruction with an absence of function or atrophy (including 1 dialysis patient who underwent bilateral RALN).
Mean tumor size was 8.2 cm, with
Comment
LN has emerged as an alternative to ORN for RCC not amenable to nephron sparing. LN is increasingly replacing ORN, as shown by Poon et al,12 in that ORN decreased from 54% of all nephrectomies in 2003 to 29% in 2010. In addition to comparable cancer control when applied judiciously, LN has demonstrated improved cosmesis and reduced morbidity.3, 4
Nevertheless, ORN continues to be performed in large numbers. This may be because laparoscopy might not be applicable to all nephrectomies even in
Conclusion
RALN is an effective method for nephrectomy and produced consistent outcomes in experienced hands regardless of procedure complexity. Avoidance of open conversion was possible even in the most complex procedures, including in morbidly obese patients, those with vascular and contiguous organ invasion, and those requiring full lymphadenectomy.
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Does size matter? Comparing robotic versus open radical nephrectomy for very large renal masses
2022, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Since the advent of robotic-assisted surgery, advances in technique have continued to expand the boundaries of what types of surgeries can be performed safely with this technology, especially in urologic surgery. Robotic-assisted RN (RRN) has shown to be safe and effective for the treatment of large and complex renal tumors in a few series [3,4]. However, there is a paucity of data directly comparing RRN to open RN (ORN) for very large renal masses.
Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies
2021, European UrologyCitation Excerpt :Moreover, the benefits arising from the minimally invasive nature shared between RRN and LRN (shorter hospital stays, quicker recovery) might be nullified by potential disadvantages (lack of tactile feedback, longer set-up times, higher overall costs) [6–8]. Some distinct features of robot-assisted surgery may be beneficial in tackling demanding procedures such as the management of large tumors, aberrant anatomy, or higher tumor stages involving contiguous organ invasion that are generally handled with ORN [9]. Locally advanced nonmetastatic RCC with venous tumor thrombosis is usually treated with RN and thrombectomy.
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2020, Urologic Clinics of North AmericaCitation Excerpt :Currently, several studies support the notion that minimally invasive RN can be safely performed even in more complex and clinically advanced cases. Depending on the study, the rates of Clavien grade IIIa or higher complications range from 3% to 10% for MIS, generally less than what is reported for ORN12,19–22 (8%–25%). There are only a few studies comparing robotic RN (RRN) with LRN.
Financial Disclosure: Ronney Abaza provides consulting and educational programs such as visiting surgeon programs for Intuitive Surgical but is not paid for these personally. Remuneration is made to education funds formerly at the Ohio State University Foundation and now with his current employer OhioHealth, and this money is used for educational programs for residents, fellows, visiting surgeons. He also has category (c) disclosures with Intuitive Surgical and SurgiQuest. The remaining authors declare that they have no relevant financial interests.