title: Initial experience with robot assisted partial nephrectomy for multiple renal masses.
abstract: OBJECTIVE
  We evaluated the feasibility of performing robot assisted partial nephrectomy in patients with multiple renal masses and examined the results of our initial experiences.
  
  
  METHODS
  We reviewed the records of 10 patients with multiple renal masses who underwent attempted robot assisted partial nephrectomy within the last 2 years. Demographic information, and intraoperative, perioperative and renal function outcome data on these patients were reviewed.
  
  
  RESULTS
  A total of 24 tumors in 9 patients were removed with robot assistance. There was 1 open conversion with successful completion of partial nephrectomy. Of the patients 70% had a known hereditary renal cancer syndrome and the remainder had multifocal disease with unknown germline genetic alterations. Frozen section from the tumor bed evaluated in 5 of 10 cases was negative. One patient experienced urinary leak postoperatively, which resolved by postoperative day 9 without intervention. Of the 24 robotically resected masses 22 were malignant. Our most recent 3 patients underwent successful partial nephrectomy without hilar clamping, obviating the need for warm ischemia. Overall renal function was unchanged at most recent followup with a minimal decrease in operated kidney differential function.
  
  
  CONCLUSIONS
  Robot assisted partial nephrectomy for multiple renal masses was feasible in our early experience. Patient selection is paramount for successful minimally invasive surgery. Robot assisted partial nephrectomy without hilar clamping, especially in the hereditary patient population in which repeat ipsilateral partial nephrectomy may be anticipated, appears promising but requires further evaluation.
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1107, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Boris
authors.forename: Miguel
authors.initials: M
authors.lastname: Proano
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics
references.citation: J Urol. 2004 Oct;172(4 Pt 1):1264-6
references.pmid: 15371820
references.citation: Cancer. 2008 Nov 15;113(10):2671-80
references.pmid: 18816624
references.citation: J Endourol. 1993 Dec;7(6):521-6
references.pmid: 8124349
references.citation: N Engl J Med. 2004 Sep 23;351(13):1296-305
references.pmid: 15385656
references.citation: Urology. 2004 Aug;64(2):255-8
references.pmid: 15302473
references.citation: Eur Urol. 2009 Mar;55(3):592-9
references.pmid: 19144457
references.citation: Eur Urol. 2008 Jun;53(6):1210-6
references.pmid: 18375044
references.citation: Obes Surg. 2007 Mar;17(3):334-40
references.pmid: 17546841
references.citation: J Urol. 2008 Jul;180(1):89-93; discussion 93
references.pmid: 18485404
references.citation: BJU Int. 2007 Jul;100(1):21-5
references.pmid: 17433034
references.citation: Urology. 2004 Nov;64(5):914-8
references.pmid: 15533477
references.citation: J Urol. 2005 May;173(5):1477-81
references.pmid: 15821463
references.citation: J Urol. 2008 Jul;180(1):104-9; discussion 109
references.pmid: 18485401
references.citation: J Urol. 2008 Dec;180(6):2353-6; discussion 2356
references.pmid: 18930263
references.citation: J Urol. 2008 Jan;179(1):67-70
references.pmid: 17997447
references.citation: J Urol. 2006 May;175(5):1630-3; discussion 1633
references.pmid: 16600716
references.citation: J Urol. 2003 Dec;170(6 Pt 1):2163-72
references.pmid: 14634372
references.citation: BJU Int. 2009 Mar;103(5):663-8
references.pmid: 18990172
references.citation: BJU Int. 2005 Feb;95(3):377-83
references.pmid: 15679798
references.citation: J Urol. 2001 Mar;165(3):777-81
references.pmid: 11176466
references.citation: J Urol. 2003 Sep;170(3):760-3
references.pmid: 12913692
references.citation: J Urol. 2000 Jul;164(1):36-9
references.pmid: 10840419