ABSTRACT
Objectives
The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy).
Materials and methods
From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (11. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146:278-82.
2. Minervini A, Tuccio A, Masieri L, Veneziano D, Vittori G, Siena G, et al. Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results. Surg Endosc. 2015;29:1241-9.
3. Luciani LG, Chiodini S, Mattevi D, Cai T, Puglisi M, Mantovani W, et al. Robotic-assisted partial nephrectomy provides better operative outcomes as compared to the laparoscopic and open approaches: results from a prospective cohort study. J Robot Surg. 2016 Dec 20.
4. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53.
5. Mikhail MS, Thangathurai D, Thaker KB, Hutchison SJ, Black DR, Chandraratna PA. Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin. J Cardiothorac Vasc Anesth. 2000;14:565-70.
6. Kumar A, Minagoe S, Thangathurai D, Mikhail M, Novia D, Viljoen JF, et al. Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe. Am J Cardiol. 1989;64:793-8.
7. Xia L, Zhang X, Wang X, Xu T, Qin L, Zhang X, et al. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg. 2016;30:109-15.
8. Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011;78:813-9.-99. Gill IS, Kamoi K, Aron M, Desai MM. 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol. 2010;183:34-41.). Average PADUA score 7.1 (55. Mikhail MS, Thangathurai D, Thaker KB, Hutchison SJ, Black DR, Chandraratna PA. Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin. J Cardiothorac Vasc Anesth. 2000;14:565-70.
6. Kumar A, Minagoe S, Thangathurai D, Mikhail M, Novia D, Viljoen JF, et al. Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe. Am J Cardiol. 1989;64:793-8.
7. Xia L, Zhang X, Wang X, Xu T, Qin L, Zhang X, et al. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg. 2016;30:109-15.
8. Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011;78:813-9.
9. Gill IS, Kamoi K, Aron M, Desai MM. 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol. 2010;183:34-41.-1010. Kim EH, Larson JA, Potretzke AM, Hulsey NK, Bhayani SB, Figenshau RS. Retroperitoneal Robot-Assisted Partial Nephrectomy for Posterior Renal Masses Is Associated with Earlier Hospital Discharge: A Single-Institution Retrospective Comparison. J Endourol. 2015;29:1137-42.). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded.
Results
All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (22. Minervini A, Tuccio A, Masieri L, Veneziano D, Vittori G, Siena G, et al. Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results. Surg Endosc. 2015;29:1241-9.
3. Luciani LG, Chiodini S, Mattevi D, Cai T, Puglisi M, Mantovani W, et al. Robotic-assisted partial nephrectomy provides better operative outcomes as compared to the laparoscopic and open approaches: results from a prospective cohort study. J Robot Surg. 2016 Dec 20.
4. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53.
5. Mikhail MS, Thangathurai D, Thaker KB, Hutchison SJ, Black DR, Chandraratna PA. Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin. J Cardiothorac Vasc Anesth. 2000;14:565-70.
6. Kumar A, Minagoe S, Thangathurai D, Mikhail M, Novia D, Viljoen JF, et al. Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe. Am J Cardiol. 1989;64:793-8.-77. Xia L, Zhang X, Wang X, Xu T, Qin L, Zhang X, et al. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg. 2016;30:109-15.). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (22. Minervini A, Tuccio A, Masieri L, Veneziano D, Vittori G, Siena G, et al. Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results. Surg Endosc. 2015;29:1241-9.
3. Luciani LG, Chiodini S, Mattevi D, Cai T, Puglisi M, Mantovani W, et al. Robotic-assisted partial nephrectomy provides better operative outcomes as compared to the laparoscopic and open approaches: results from a prospective cohort study. J Robot Surg. 2016 Dec 20.
4. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844-53.
5. Mikhail MS, Thangathurai D, Thaker KB, Hutchison SJ, Black DR, Chandraratna PA. Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin. J Cardiothorac Vasc Anesth. 2000;14:565-70.
6. Kumar A, Minagoe S, Thangathurai D, Mikhail M, Novia D, Viljoen JF, et al. Noninvasive measurement of cardiac output during surgery using a new continuous-wave Doppler esophageal probe. Am J Cardiol. 1989;64:793-8.-77. Xia L, Zhang X, Wang X, Xu T, Qin L, Zhang X, et al. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg. 2016;30:109-15.).
Conclusions
The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
Keywords
Nephrectomy; Video-Assisted Surgery; Laparoscopy
