title: Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy.
abstract: Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm(2) , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy will be more frequently carried out as a safe, effective and minimally-invasive nephron-sparing surgery procedure.
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Shiroki
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Fukami
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Fukaya
authors.affiliation: Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kusaka
authors.affiliation: Faculty of Radiological Technology, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Natsume
authors.affiliation: Faculty of Radiological Technology, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichihara
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toyama
mesh_terms: D006801:Humans; D007564:Japan; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: kidney tumor; nephron-sparing surgery; robot-assisted partial nephrectomy; warm ischemic time