title: [Robot-assisted laparoscopic partial nephrectomy using daVinci S-surgical system for localized renal tumor: report of initial five cases].
abstract: OBJECTIVE
  For the management of patients with small renal tumor, laparoscopic partial nephrectomy (LPN) provides similar oncological control as radical nephrectomy (RN) and is superior to RN with respect to preserving renal function and preventing chronic kidney disease (CKD). The challenge of LPN is to resect a tumor in a bloodless field within a limited warm ischemia time (WIT) , followed by hemostatic renorrhaphy under restricted movement of laparoscopic forceps. Therefore, LPN still remains challenging to even experienced laparoscopic surgeon. DaVinci device improved the movability of forceps in LPN and provided three-dimensional visualization. We evaluated outcome and safety of our first series of robot-assisted laparoscopic partial nephrectomy (RALPN) for localized kidney tumor. There was no previous report of RALPN undertaken in our country.
  
  
  METHODS
  Since August 2010, our team carried out RALPN for a total of five cases of renal tumor. There were four males and one female with an age range of 41 to 65 years-old. Size of tumor ranged from 15 to 28 mm, located in exophytic region, and four cases in right side and one in left. RALPN was undertaken by single surgeon through transperitoneal approach in two cases and retroperitoneal in tree.
  
  
  RESULTS
  RALPN was completed in all patients without conversion to open or hand-assisted surgery. The median operative time and the estimated blood loss were 189 minutes, ranged from 150 to 264, and 29 ml, from 10 to 50, respectively. The median volume of removed tumor and the length of WIT were 7 g, ranged from 4 to 13 g, and 18 minutes, from 13 to 26 minutes, respectively. No complications or reoperations were associated during or post our RALPN cases. Pathological examination of removed tumor showed renal cell carcinoma with negative surgical margin in all cases.
  
  
  CONCLUSIONS
  Introduction of daVinci device to LPN made this procedure, RALPN, a secured and promising one, which leading to shorten the WIT and to achieve satisfied renorrhaphy. Even for the complex and technically challenging renal tumors, robotic assistance is expected to provide patients the benefit of minimally invasive surgery with safety and satisfactory renal function.
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Shiroki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Maruyama
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kusaka
authors.forename: Shigeto
authors.initials: S
authors.lastname: Washida
authors.forename: Masaru
authors.initials: M
authors.lastname: Hikichi
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Morikawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hirano
authors.forename: Naohiko
authors.initials: N
authors.lastname: Fukami
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Hoshinaga
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics / Q000295:instrumentation*