Current status of robotic partial nephrectomy (RPN)

Abstract

What's known on the subject? and What does the study add? Nephron‐sparing surgery is now the gold standard for the treatment of small renal masses. Robotic partial nephrectomy represents an emerging minimally‐invasive option for nephron‐sparing surgery. Initial case series have described the evolution of technique and perioperative outcomes. This review summarizes recent case series regarding robotic partial nephrectomy and provides an analysis of studies comparing robotic partial nephrectomy to laparoscopic partial nephrectomy. Exciting technical advances are centered around reducing ischemia time. Finally, future directions for robotic partial nephrectomy include options for cold ischemia, real‐time integration of radiographic imaging, and advancements in robotic technology. OBJECTIVE Robotic partial nephrectomy (RPN) is a minimally invasive option for patients undergoing nephron‐sparing surgery (NSS). As the technique of RPN develops and matures, intraoperative and perioperative outcomes continue to be reported. In the current review, we discuss safety, efficacy, and recent technical advances in RPN. METHODS A Medline search using the keywords ‘partial nephrectomy’, ‘robotic partial nephrectomy’, ‘robot partial nephrectomy’, ‘robot‐assisted laparoscopic partial nephrectomy’, and ‘laparoscopic partial nephrectomy’ was conducted to identify original articles, review articles, and editorials on RPN. RESULTS There have been multiple recent retrospective studies comparing RPN with laparoscopic PN (LPN). These comparisons suggest a shorter learning curve for RPN and confirm the safety and feasibility of RPN, even for select complex renal masses. Novel techniques have been developed in efforts to decrease warm ischaemia time. These include use of sliding‐clip renorrhaphy, selective renal parenchymal clamping, and ‘early unclamping’ or ‘no‐clamp’ techniques. CONCLUSIONS RPN appears to be a viable minimally invasive option for NSS. RPN may reduce some of the technical challenges associated with LPN, and thus, extend the potential benefits of minimally invasive NSS to a larger population. Further studies of the long‐term renal functional outcomes and oncological efficacy of RPN are needed before fully advocating this technique.