title: Early experience and operative technique of robotic-assisted partial nephrectomy.
abstract: BACKGROUND
  The adoption of robotic-assisted partial nephrectomy (RAPN) is increasing in Australia; however, to date no Australian RAPN series has been reported. This paper describes a single-surgeon initial experience with RAPN and evaluates perioperative, pathological and oncological outcomes.
  
  
  METHODS
  Data on the first 50 consecutive patients to undergo RAPN by a single surgeon were reviewed. Demographic, perioperative, tumour characteristics and Clavien complications were collected in addition to oncological follow-up and renal function monitoring.
  
  
  RESULTS
  Mean age was 58.2 ± 10.4 years, body mass index was 28.8 ± 4.5 kg/m(2) and Charlson Co-morbidity Index was 4.6 ± 1.2. Tumour diameter was 31 ± 13 mm and RENAL score was 6.8 ± 1.5. Average total operative time was 151 ± 32.7 min, estimated blood loss was 171.1 ± 185.8 mL, warm ischaemia time was 17.8 ± 6.7 min and length of hospital stay was 3 ± 0.9 days. There were seven Clavien complications and no deaths. Estimated glomerular filtration rate did not decrease significantly post-operatively (P = 0.8); and there was 14.6% upstaging of chronic kidney disease scoring although no patient required dialysis. There were no positive malignant surgical margins, and to date no patient has evidence of disease recurrence. Of 50 patients, 54% had a minimum follow-up of 6 months and 28% had a minimum follow-up of 1 year.
  
  
  CONCLUSIONS
  We report the largest RAPN study in Australia or New Zealand to date. Initial results suggest that RAPN can be safely introduced into the Australian public and private health systems, and has been effective in oncologic control and renal function preservation.
authors.affiliation: School of Medicine, University of Queensland, St. Lucia, Queensland, Australia.
authors.forename: John R
authors.initials: JR
authors.lastname: Kucharczyk
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|MDHS, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Marnique
authors.initials: M
authors.lastname: Basto
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Urology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Landau
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Urology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Reid
authors.initials: R
authors.lastname: Graves
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Urology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Wouter
authors.initials: W
authors.lastname: Everaerts
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Birch
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|MDHS, The University of Melbourne, Melbourne, Victoria, Australia.|Department of Urology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Urology, Epworth Healthcare Richmond, Melbourne, Victoria, Australia.|Australian Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.|Department of Urology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Australian Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.|Department of Urology, Cabrini Healthcare, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D052096:Warm Ischemia
keywords: nephron sparing surgery; renal cancer; robot-assisted partial nephrectomy; robotic surgery