title: Robotic nephrectomy for the treatment of benign and malignant disease.
abstract: OBJECTIVE
  To report our experience and describe our technique of robotic nephrectomy.
  
  
  METHODS
  We retrospectively evaluated 42 patients who underwent robotic nephrectomy at our institution from January 2004 to March 2008. Variables assessed included patient age, body mass index, operative duration, estimated blood loss (EBL), complications, hospital stay, analgesia requirements and specimen pathology. Radical nephrectomy (RN) was performed for suspected malignant disease and simple nephrectomy (SN) was performed for benign disease.
  
  
  RESULTS
  In all, 42 patients with a mean (range) age of 59.4 (17-38) years, underwent robotic nephrectomy (RN 35, SN seven) using a transperitoneal (39) or retroperitoneal (three) approach. The mean operative console time was 158 min, mean EBL was 223 mL, mean tumour size was 5.1 cm, and the mean hospital stay was 2.4 days. Renal hilar vessels were controlled using robotic suture ligation (25), robotic haemolock clips (12), or laparoscopic staplers (five). No patients required open conversion. One morbidly obese patient developed a wound dehiscience (complication rate 2.6%). On final tumour pathology, the RN specimens included 34 renal cell carcinomas (clear cell 23, papillary nine, chromophobe two) and an oncocytoma. The SN specimens showed chronic xanthogranulomatous pyelonephritis (four) and atrophic kidneys (three). All surgical margins were negative for malignancy with no evidence of tumour recurrence at a mean (range) follow-up of 15.7 (1-51) months.
  
  
  CONCLUSIONS
  Robotic nephrectomy is a safe and feasible option for minimally invasive surgical removal of the kidney for benign and malignant conditions and can be performed through a transperitoneal or retroperitoneal approach.
authors.affiliation: Henry Ford Hospital, Vattikuti Urology Institute, Detroit, MI 48202, USA. crogers2@hfhs.org
authors.forename: Craig
authors.initials: C
authors.lastname: Rogers
authors.forename: Rajesh
authors.initials: R
authors.lastname: Laungani
authors.forename: Louis Spencer
authors.initials: LS
authors.lastname: Krane
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: Mahendra
authors.initials: M
authors.lastname: Bhandari
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D055815:Young Adult