title: da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy is gaining acceptance as an alternative to open surgery for small renal tumours, although technical difficulty of intracorporeal suturing and concerns over warm ischemia time are limitations. Previous work has demonstrated that suturing with the robotic system is easier compared with laparoscopy. We believe the robot has an application and we report our initial experience in 10 patients undergoing robotic partial nephrectomy.
  
  
  METHODS
  Ten patients with small exophytic renal masses underwent intraperitoneal robotic partial nephrectomy. Principles of traditional open surgery were followed and intraoperative ultrasound was used to define resection margins. The renal artery was clamped with laparoscopic bulldog clamps and indigo carmine was administered intravenously to detect entry into collecting system. Suture closure and FLOSEAL were used for hemostasis. Frozen sections were obtained in all patients.
  
  
  RESULTS
  Seven men and three women, mean age 59 yr, underwent robotic partial nephrectomy. Mean tumour size was 2 cm. Mean console and warm ischemia time were 158 min and 21 min, respectively. The median hospital stay was 1.5 d. Pathology revealed renal cell carcinoma in eight, oncocytoma in one, and lipoma in one. All resection margins were negative. Follow-up ranged from 6 to 28 mo.
  
  
  CONCLUSIONS
  Robotic partial nephrectomy is a viable alternative to open or laparoscopic partial nephrectomy in carefully selected patients with small renal tumours. The advantages of the robotic system must be weighed against its cost. Further studies will determine if reduction in procedure complexity warrants the expense of such technology.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA. skaul1@hfhs.org
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Rajesh
authors.initials: R
authors.lastname: Laungani
authors.forename: Richard
authors.initials: R
authors.lastname: Sarle
authors.forename: Hans
authors.initials: H
authors.lastname: Stricker
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.forename: Ray
authors.initials: R
authors.lastname: Littleton
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012371:Robotics / Q000379:methods*