ROBOTIC ASSISTED PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL MASSES: FEASIBILITY AND RESULTS OF INITIAL EXPERIENCE

Abstract

It has been shown that partial nephrectomy provides cancer control equal to that of radical nephrectomy in selected patients with renal neoplasms.1 Laparoscopic partial nephrectomy was introduced in 1993 and more recently robot assisted partial nephrectomy has been described as a minimally invasive alternative to open partial nephrectomy.2,3 Initially introduced to excise small exophytic renal masses, these techniques have evolved into procedures duplicating open surgery and have facilitated the safe and accurate removal of larger and more endophytic lesions.4 Not much is known, however, about the role of laparoscopy for management of multifocal renal masses. It has been shown that the incidence of multifocal disease ranges from 6–25% in the sporadic population.5 Multifocality is considerably higher in the hereditary renal cancer population, such as in patients with von Hippel-Lindau, hereditary papillary renal carcinoma and Birt-Hogg-Dube. Even in high volume centers with laparoscopic expertise, the constraints of warm ischemia time needed for resection of multiple tumors typically directs the surgeon towards an open approach. Additionally, in the hereditary kidney population or in patients with multifocal renal masses, the known risk of recurrence or de novo tumor formation is much greater than in the general population. This frequently requires repeat intervention associated with higher morbidity, and it has underscored our quest towards maximizing tumor removal while minimizing hilar dissection and clamping in the open as well as the laparoscopic setting. In the current study we present our initial experience with robot assisted partial nephrectomy for 2 or more ipsilateral renal masses to evaluate the utility of minimally invasive surgery in the management of multifocal renal disease.