Initial Clinical Experience With Surgical Technique of Robot-assisted Transperitoneal Laparoscopic Partial Nephrectomy

摘要

BACKGROUND: The incidental finding of small renal masses has increased due to widespread use of computed tomography as a diagnostic procedure. Some patients with either exophytic renal masses less than 4 cm and suboptimal renal function, a solitary kidney and bilateral renal tumors, or genetic predisposition to renal tumors are considered candidates for laparoscopic partial nephrectomy (LPN). A technical difficulty of LPN is performing laparoscopic intracorporeal suturing under the pressure of warm ischemia time. Because robotic systems have been shown to provide easier intracorporeal suturing, we hypothesized that robotic-assisted LPN might improve efficacy. METHODS: Eight patients with a mean age of 41 years and mean tumor size of 2.3 cm underwent robot-assisted LPN between September 2006 and December 2008. Tumor excision and intracorporeal suturing under warm ischemia by renal artery clamp were performed entirely using a robotic system. All perioperative data and pathologic results were reviewed retrospectively. RESULTS: The mean operation time was 160 minutes, and the mean estimated blood loss was 165 mL. The mean warm ischemia time was 33 minutes, and mean postoperative hospital stay was 4.3 days. Average preoperative hemoglobin was 13.0 mg/dL and postoperative hemoglobin was 11.8 mg/dL. Average preoperative creatinine was 1.1 ng/mL and postoperative creatinine was 1.28 ng/mL. There was 1 conversion to laparoscopic nephrectomy due to a positive margin on a frozen section after discussion with family about better oncologic control. The resected lesions included renal cell carcinoma in 5 patients, angiomyolipoma in 2, and a renin-secreting renal tumor in 1 patient. CONCLUSION: Robot-assisted LPN is feasible and may be a viable alternative to open or LPN in selected patients with small exophytic renal tumors. Compared with standard LPN, the robotic assisted LPN approach with precise renal reconstruction under a safe warm ischemia time is feasible and can be easily adopted by those with experience in robot-assisted surgery.