title: Robot-assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours.
abstract: OBJECTIVE
  To report our short-term results of robot-assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours.
  
  
  METHODS
  Over a 3-year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution. We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes.
  
  
  RESULTS
  In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150-300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6-4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4-4.8). Mean number of tumours removed per patient was 2.4. Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non-hilar position), respectively. Excluding the six off-clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10-35). Mean estimated blood loss was 250 ± 154 mL (200; 100-500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti-arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days. Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II. The mean decrease in glomerular filtration rate was 4%, with a mean follow-up of 14 months.
  
  
  CONCLUSIONS
  Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe. Off-clamp resection of multiple tumours can also be safely performed in carefully selected lesions.
authors: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, OH, USA.
authors: Humberto
authors: H
authors: Laydner
authors: Riccardo
authors: R
authors: Autorino
authors: Gregory
authors: G
authors: Spana
authors: Fatih
authors: F
authors: Altunrende
authors: Bo
authors: B
authors: Yang
authors: Rakesh
authors: R
authors: Khanna
authors: Michael A
authors: MA
authors: White
authors: Wahib
authors: W
authors: Isac
authors: Shahab
authors: S
authors: Hillyer
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Robert J
authors: RJ
authors: Stein
authors: Jihad H
authors: JH
authors: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia