title: 252 robotic partial nephrectomies: evolving renorrhaphy technique and surgical outcomes at a single institution.
abstract: OBJECTIVE
  To describe the evolution of robotic partial nephrectomy (PN) technique and to analyze the surgical outcomes in a large single institution experience.
  
  
  METHODS
  Retrospective review of our institutional review board-approved, prospectively maintained, minimally invasive PN database yielded 252 robotic partial nephrectomy (RPN) procedures from June 2007 to October 2010. Our initial experience, adopted from our laparoscopic PN approach included a standard interrupted bolstered renorrhaphy, whereas our contemporary experience included a nonbolstered continuous horizontal mattress stitch for the capsular closure. Perioperative results were evaluated depending on renorrhaphy technique, length of warm ischemia time, and nephrometry scores.
  
  
  RESULTS
  Overall, mean tumor size was 3.1 ± 1.6 cm, operative time 190 ± 56 minutes, warm ischemia time 18.2 ± 9.4 minutes, and estimated blood loss 267 ± 275 mL. Significantly better outcomes were noted in the contemporary experience in terms of transfusion rate (8.2% vs 21.9%, P <.001), operative time (181 vs 219 minutes, P <.001), hospital stay (3.6 vs 4.3 days, P = .02), and complication rate (14.4% vs 33.8%, P <.01). Increasing tumor complexity based on RENAL score predicted longer operative time (P <.0001), warm ischemia time (P <.0001), and hospital stay (P <.04), and a greater risk of postoperative complications (P = .003). Of the series, only 2 patients had hemorrhagic complications (0.8%) requiring angioembolization, 4 patients developed urine leaks (1.5%), and 2 positive margins (0.8%) were noted.
  
  
  CONCLUSIONS
  We report the largest single-institution study with RPN to date. Despite it being a relatively nascent procedure, initial results suggest that RPN is an effective approach for minimally invasive nephron-sparing surgery. As experience is gained and the technique for RPN evolves, further improvement in outcomes will be noted.
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. kaoukj@ccf.org
authors: Jihad H
authors: JH
authors: Kaouk
authors: Shahab P
authors: SP
authors: Hillyer
authors: Riccardo
authors: R
authors: Autorino
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Tianming
authors: T
authors: Gao
authors: Fatih
authors: F
authors: Altunrende
authors: Rakesh
authors: R
authors: Khanna
authors: Gregory
authors: G
authors: Spana
authors: Michael A
authors: MA
authors: White
authors: Humberto
authors: H
authors: Laydner
authors: Wahib
authors: W
authors: Isac
authors: Robert J
authors: RJ
authors: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult