title: Robotic partial nephrectomy for solitary kidney: a multi-institutional analysis.
abstract: OBJECTIVE
  To evaluate the outcomes of robotic partial nephrectomy (RPN) for solitary kidney in a large multicenter series.
  
  
  METHODS
  Medical records of 886 consecutive patients who underwent RPN at 5 academic institutions from May 2007 to May 2012 were retrospectively analyzed. Data were prospectively collected in an Investigational Review Board-approved protocol. Experienced robotic surgeons performed all operations. Patient demographics, functional, perioperative, and early oncologic outcomes were analyzed.
  
  
  RESULTS
  A total of 26 patients with a solitary kidney were identified and included in the analysis; of these, 16 (62%) had solitary kidneys secondary to a previous malignancy. Perioperative outcomes included a median warm ischemia time of 17 minutes (interquartile range, 12, 28 minutes). Only 2 intraoperative complications occurred. One was a renal vein injury and one an aortic vessel tear, and both patients required intraoperative blood transfusions. No conversions to laparoscopy or open surgery occurred. There were 3 postoperative complications (11.5%). Median follow-up was 6 months (interquartile range, 5, 9.7 months). Postoperative renal function did not change significantly as measure by estimated glomerular filtration rate (-15.8%; P=.13). None of the patients required dialysis. Positive margins occurred in 1 patient, with 73% of patients having a renal cell carcinoma.
  
  
  CONCLUSIONS
  We report a multi-institutional series of RPN in patients with solitary kidney presenting with small renal masses. Our findings suggest that RPN represents a feasible treatment option in this specific population by offering reliable preservation of renal function, low surgical morbidity, and early oncologic safety in the hands of experienced robotic surgeons.
authors.affiliation: Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Shahab P
authors.initials: SP
authors.lastname: Hillyer
authors.forename: Sam B
authors.initials: SB
authors.lastname: Bhayani
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tanagho
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Mullins
authors.forename: Yichun
authors.initials: Y
authors.lastname: Chiu
authors.forename: Bartosz F
authors.initials: BF
authors.lastname: Kaczmarek
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D001011:Aorta / Q000293:injuries; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D012082:Renal Veins / Q000293:injuries; D012189:Retrospective Studies; D012371:Robotics; D052096:Warm Ischemia