title: Four-arm robotic partial nephrectomy for complex renal cell carcinoma.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Second Affiliated Hospital, Zhejiang University College of Medicine, 310009 Hangzhou, Zhejiang, China. gong_david@zju.edu.cn
authors.forename: Yu
authors.initials: Y
authors.lastname: Gong
authors.forename: Chuanjun
authors.initials: C
authors.lastname: Du
authors.forename: David Y
authors.initials: DY
authors.lastname: Josephson
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Wilson
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nelson
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*