Robot-assisted partial nephrectomy: evolution and recent advances.
OBJECTIVE
Robot-assisted partial nephrectomy (RAPN) is emerging as a viable complement to traditional laparoscopic and open partial nephrectomy. As a relatively new technique, the techniques and technologies employed during RAPN continue to evolve. In the present article, we provide an overview of the evolution of robot-assisted renal surgery, and highlight the recent advances that have helped to bring RAPN to the fore.


RESULTS
The learning curve for RAPN appears to be slight, and technical proficiency may be quickly achieved, even for those with limited laparoscopic experience. Recent advances include improvements in ergonomics of the robotic system itself, as well as the introduction of sliding-clip renorrhaphy, early unclamping techniques, and off-clamp techniques. Early-to-intermediate outcomes are very promising, demonstrating short warm ischemic times, and a low rate of complication and recurrence. Disadvantages to the approach include substantial cost, as well as increased reliance upon the assistant to perform critical maneuvers.


CONCLUSIONS
Robot-assisted partial nephrectomy appears to be a safe and efficacious technique for the surgical management of localized renal malignancy. Recent developments have focused upon reducing ischemic insult, as well as decreasing reliance upon the assistant.
Benway
Brian M
BM
Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA. benwayb@wudosis.wustl.edu
Bhayani
Sam B
SB
D006801:Humans; D009392:Nephrectomy / Q000379:methods* / Q000639:trends; D012371:Robotics