Current role of robotic assisted partial nephrectomy.
The modern urologists are nowadays greatly involved in the surgical management of small renal masses, where nephron sparing surgery showed adequate oncological results, with a saving of a great amount of healthy renal tissue. Among the various minimally invasive surgical options, laparoscopic partial nephrectomy duplicates the open technique considered the standard of referral. Robotic assisted partial nephrectomy, aims to add to laparoscopy all the well known advantages offered by the Da Vinci system, such as the 3-Dvision and 7 degree of freedom of surgical instruments. We reviewed the current English literature on robotic partial nephrectomy published in 2008-2009 with at least 20 cases, adding our experience of 26 cases. Although the retroperitoneoscopic approach showed to be feasible in selected cases, all the procedures reported were performed with a transperitoneal approach. Among the 106 robotic assisted partial nephrectomy procedures selected, the mean tumor diameter was 2.8 cm; the mean operative time was 148.7 min with a mean warm ischemia time of 23.8 min and the positive surgical margins rate was 1.8%, reflecting the learning curve of the procedure. Overall complications rate was 15%, although the majority were minor and conservatively treated. Although robotic partial nephrectomy is still in its infancy, it showed adequate overall results when compared to laparoscopic partial nephrectomy with similar results but with a reduced learning curve. Actually robotic partial nephrectomy should be considered a viable option for nephron sparing surgery both in experienced laparoscopy centers for larger lesions in robotic naive centers where it may become the standard option for the treatment of small renal masses.
Cestari
Andrea
A
Department of Urology, Vita-Salute University, San Raffaele Turro Hospital, Milan, Italy. a_cestari@yahoo.it
Guazzoni
Giorgio
G
Buffi
Nicolò Maria
NM
Scapaticci
Emanuele
E
Zanoni
Matteo
M
Fabbri
Fabio
F
Gadda
Giulio
G
Rigatti
Patrizio
P
D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D052096:Warm Ischemia