title: Feasibility of robotic laparoendoscopic single-site partial nephrectomy for renal tumors >4 cm.
abstract: BACKGROUND
  Laparoendoscopic single-site (LESS) urologic procedures have gained significant interest worldwide in an attempt to further reduce morbidity and minimize scarring associated with conventional laparoscopic surgery. The robotic technology has overcome some of the limitations of manual single-incision surgery relating to lack of triangulation, instrument collision, and surgical exposure. There are no data on robotic LESS partial nephrectomy (PN) for renal tumors >4 cm.
  
  
  OBJECTIVE
  To evaluate the feasibility of robotic LESS PN for renal tumors >4 cm.
  
  
  METHODS
  Data from 67 consecutive patients who underwent robotic LESS PN were collected between May 2009 to January 2011.
  
  
  METHODS
  Patients were stratified into two groups: 20 patients with renal tumors >4 cm (group 1) and 47 patients with renal tumors ≤ 4 cm (group 2). Perioperative data were recorded and comparisons between the two groups were analyzed using the Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables.
  
  
  CONCLUSIONS
  No statistically significant differences were found between the two groups in demographic information, operative complications, pathologic characteristics, mean decline in estimated glomerular filtration rate, estimated blood loss, operative times, conversion rate, or positive surgical margins. However, group 1 had a higher mean nephrometry score (p<0.01), longer warm ischemia time (p = 0.007), and longer length of stay (p = 0.046). Its retrospective design and being conducted at a single center were the main limitations of this study.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility and safety of robotic LESS PN for tumors >4 cm. Patients with tumors >4 cm had a statistically significant, higher mean nephrometry score, longer warm ischemia time, and longer length of stay, but there was no increased risk of adverse outcomes. A long-term study is needed to confirm the durable renal preservation and oncologic outcomes for patients with larger tumor burden.
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Tiu
authors.forename: Kwang H
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae Y
authors.initials: TY
authors.lastname: Shin
authors.forename: Woong K
authors.initials: WK
authors.lastname: Han
authors.forename: Sang W
authors.initials: SW
authors.lastname: Han
authors.forename: Koon H
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D052096:Warm Ischemia; D055815:Young Adult