title: Outcomes of Robotic Nephrectomy Including Highest-complexity Cases: Largest Series to Date and Literature Review.
abstract: OBJECTIVE
  To review the outcomes of robot-assisted laparoscopic nephrectomy (RALN) after 101 consecutive cases, the largest reported series to date. The benefit of adding robotic technology to laparoscopic nephrectomy is unclear and controversial. We used robotics for nephrectomy routinely, including for simpler cases rather than laparoscopy, as well as for the most complex nephrectomies rather than open surgery.
  
  
  METHODS
  We reviewed a prospective database of 101 consecutive nephrectomy procedures by a single surgeon (R.A.). All were initiated as RALN regardless of complexity. Patient characteristics and outcomes were reviewed, including tumor complexity, conversion rate, transfusions, length of stay, and complications.
  
  
  RESULTS
  Mean age was 60 years (19-86 years), and mean body mass index was 31 kg/m(2) (16-54 kg/m(2)). Ninety patients had tumors with mean size of 8.2 cm (2.2-25.8 cm). Eighty were malignant, including 31 pT3a tumors (39%), with 9 renal vein thrombi. Eight malignancies had caval tumor thrombi (10%). Local invasion required 1 bowel resection, 1 partial hepatectomy, and 1 distal pancreatectomy, all performed robotically with no conversions to open surgery. Ipsilateral retroperitoneal lymphadenectomy was performed in 40 patients removing 13.7 nodes (4-36). Mean operative time and blood loss were 172 minutes (57-411 minutes) and 67 mL (10-400 mL) with only 1 transfusion (1%). Mean length of stay was 1.1 days (0-7 days), with 94% discharged by postoperative day 1. Clavien grade III-IV complications occurred in 5% without deaths.
  
  
  CONCLUSIONS
  Robotic nephrectomy allows for consistent outcomes regardless of procedure complexity. Completion of procedures without need for open conversion was possible even in the most complex procedures, including those with vascular and contiguous organ invasion.
authors.affiliation: Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH. Electronic address: firas.petros@osumc.edu.
authors.forename: Firas G
authors.initials: FG
authors.lastname: Petros
authors.affiliation: Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Angell
authors.affiliation: Department of Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D055815:Young Adult