title: [Impact of robotic assistance on the use and the outcomes of nephron-sparing surgery: A single center experience].
abstract: BACKGROUND
  The aim of this study was to assess the impact of the acquisition of a Da Vinci®robot on the use and outcomes of partial nephrectomy (PN).
  
  
  METHODS
  It was a single center retrospective study including 280 patients who underwent PN from January 2006 to May 2013. The number of PN, tumors and patients' characteristics and perioperative outcomes have been assessed over 3 periods defined according to the main surgical approach: 2006-2008 (open PN), 2008-2010 (laparoscopic PN) and 2010-2013 (robotic PN).
  
  
  RESULTS
  Over the study period, the surgical approach has changed significantly in favor of minimally-invasive surgery and especially robotic approach. The PN/nephrectomy rate has also evolved to a higher proportion of PN over radical nephrectomy (P=0.002). No significant difference was noted between the three periods in terms of tumor size but there was a higher rate of highly complex tumors (RENAL score≥10) during the last period (10.7%; 18.6% and 33.2%; P=0.04). Warm ischemia time increased from 2006-2008 to 2008-2010 (26 vs. 23minutes) but decreased thereafter during the robotic era (14.5minutes; P<0.001). Regarding postoperative outcomes, the only change was a decreased length of stay over time (P=0.003).
  
  
  CONCLUSIONS
  In this single center series, the robotic approach was associated with a spread of PN and with an improvement of nephron-sparing surgery outcomes.
  
  
  METHODS
  4.
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: T
authors.initials: T
authors.lastname: Fardoun
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France. Electronic address: peyronnetbenoit@hotmail.fr.
authors.forename: B
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Service de pharmacologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Oger
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Khene
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Pradere
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Alimi
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Manunta
authors.affiliation: Service d'anatomopathologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: N
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Service d'urologie, CHU Kremlin-Bicêtre, 94043 Le Kremlin-Bicêtre, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Patard
authors.affiliation: Service d'anatomopathologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: S-F
authors.initials: SF
authors.lastname: Kammerer-Jacquet
authors.affiliation: Service d'urologie, CHU de Rennes, 35000 Rennes, France.
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
mesh_terms: D006801:Humans; D007680:Kidney Neoplasms; D010535:Laparoscopy; D009392:Nephrectomy; D009399:Nephrons; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Kidney neoplasms; Néphrectomie partielle; Outcomes; Partial nephrectomy; Robot; Résultats; Tumeurs rénales