title: Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes.
abstract: BACKGROUND
  Multifocal and hereditary kidney cancers often require repeated ipsilateral nephron sparing procedures with higher blood loss and complication rates compared to first time renal surgery. Consequently, many surgeons avoid minimally invasive techniques in the setting. We present the characteristics, complications, and short-term renal functional outcomes of patients who underwent a repeat robotic partial nephrectomy (rRPNx).
  
  
  METHODS
  A database was retrospectively reviewed to identify patients who underwent robotic partial nephrectomies between January 2007 and December 2013. Selection criteria for the rRPNx cohort included patients who had undergone at least two ipsilateral renal surgeries, with the second procedure being an rRPNx. All other patients comprised the initial robotic partial nephrectomy (iRPNx) group.
  
  
  RESULTS
  One hundred twenty-four patients who underwent robotic partial nephrectomy during the study period were identified. rRPNx constituted 26 (21%) of the total cases. Age of the rRPNx cohort was similar (p = 0.56), but number of tumors resected was two-fold greater in the rRPNx group (p = 0.44). Neither surgery time nor renal clamp time was significantly longer in either group (p = 0.18 and p = 0.65, respectively). Importantly, estimated blood loss (EBL) was significantly larger than in the iRPNx group (p = 0.01). Both groups had similar intravenous pain medication administration durations (p = 0.32), but postsurgical length of stay was greater for the rRPNx patients (p = 0.011). There were no significant differences in clavian complication rates (p = 0.17-0.39), with the exception of urine leak which occurred more frequently in the rRPNx group (p = 0.01). There was no difference in percent change in serum creatinine or estimated glomerular filtration rate (p = 0.89 and p = 0.67, respectively).
  
  
  CONCLUSIONS
  rRPNx is safe and feasible in select patients. EBL, postoperative lengths of stay, and urine leak were the only factors significantly associated with rRPNx compared to iRPNx. Patient 3-month follow-up revealed excellent and comparable outcomes between the two groups.
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Watson
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Sidana
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Annerleim Walton
authors.initials: AW
authors.lastname: Diaz
authors.affiliation: 2 Department of Urology, University of Maryland , Baltimore, Maryland.
authors.forename: M Minhaj
authors.initials: MM
authors.lastname: Siddiqui
authors.affiliation: 3 Department of Urology, Georgetown University Hospital , Washington, District of Columbia.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Hankins
authors.affiliation: 4 Department of Urology, Upstate Medical University , Syracuse, New York.
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.affiliation: 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Metwalli
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery; D061646:Operative Time; D018579:Patient Selection; D011184:Postoperative Period; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003404:Creatinine
keywords: laparoscopy approach; renal cancer; robotics