title: Robot-assisted partial nephrectomy: an international experience.
abstract: BACKGROUND
  Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients.
  
  
  OBJECTIVE
  We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and oncologic outcomes.
  
  
  METHODS
  A retrospective chart review was performed for 183 patients who underwent RAPN at four centers between 2006 and 2008.
  
  
  METHODS
  RAPN was performed using methods outlined in the supplemental video material. Though operative technique was similar across all institutions, there were minor variations in trocar placement and hilar control.
  
  
  METHODS
  Perioperative parameters, including operative time, warm ischemic time, blood loss, and perioperative complications were recorded. In addition, we reviewed functional and oncologic outcomes.
  
  
  CONCLUSIONS
  Mean age at treatment was 59.3 yr. Mean tumor size was 2.87 cm. Mean total operative time was 210 min while mean ischemic time was 23.9 min. Calyceal repair was required in 52.1% of procedures. Mean estimated blood loss was 131.5 ml. Sixty-nine percent of excised tumors were malignant, of which 2.7% exhibited positive surgical margins. The incidence of major complications was 8.2%. At up to 26 mo follow-up, there have been no documented recurrences and no significant change in serum creatinine (1.03 vs 1.04 mg/dl, p=0.84) or estimated glomerular filtration rate (eGFR) from baseline (82.2 vs 79.4 mg/ml per square meter, p=0.74). The study is limited by its retrospective nature, and the outcomes are likely influenced by the robust prior laparoscopic renal experience of each of the surgeons included in this study.
  
  
  CONCLUSIONS
  RAPN is a safe and efficacious approach for NSS, offering short ischemic times, as well as perioperative morbidity equivalent to other standard approaches. Moreover, RAPN is capable of providing patients with excellent functional and oncologic outcomes.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA. benwayb@wudosis.wustl.edu
authors.forename: Brian M
authors.initials: BM
authors.lastname: Benway
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: James R
authors.initials: JR
authors.lastname: Porter
authors.forename: Nicolò M
authors.initials: NM
authors.lastname: Buffi
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D014481:United States