title: Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature.
abstract: OBJECTIVE
  Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature.
  
  
  METHODS
  Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients ' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature.
  
  
  RESULTS
  Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up.
  
  
  CONCLUSIONS
  Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses. Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.
authors.affiliation: Urology Department, Faculdade de Medicina da Universidade de Sao Paulo-FMUSP, Sao Paulo, Brazil. carlopasserotti@hotmail.com
authors.forename: Carlo Camargo
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Pessoa
authors.forename: Jose Arnaldo Shiomi
authors.initials: JA
authors.lastname: da Cruz
authors.forename: Marcelo Takeo
authors.initials: MT
authors.lastname: Okano
authors.forename: Alberto Azoubel
authors.initials: AA
authors.lastname: Antunes
authors.forename: Adriano Joao
authors.initials: AJ
authors.lastname: Nesrallah
authors.forename: Marcos Francisco
authors.initials: MF
authors.lastname: Dall'oglio
authors.forename: Enrico
authors.initials: E
authors.lastname: Andrade
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D001938:Brazil; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D047368:Tumor Burden