Strategies for success: A multi-institutional study on robotic partial nephrectomy for complex renal lesions.

Abstract

OBJECTIVE:

Due to their size, location and proximity to the hilum, some complex renal tumours may preclude a minimally invasive approach to nephron sparing surgery. We describe our technique, illustrated with images and videos, of robotic partial nephrectomy for challenging renal tumours.

PATIENTS AND METHODS:

A study of 249 patients who underwent robotic partial nephrectomy (RPN) in multiple institutions was performed. Patients were identified using prospective RPN databases. A complex renal lesion was defined as a RENAL nephrometry score ≥10. Data was presented as median (interquartile range) and differences between groups were examined.

RESULTS:

31 (12.4%) RPN were performed for complex renal tumours. Median age was 57 (50.5 - 70.5) years. 21 (67.7%) were male, 10 (32.3%) were female. American Society of Anesthesiologists score was 2 (2 - 3). Median operative time was 200 (50 - 265) min, median warm ischaemia time was 23 (18.5 - 29) min, and median blood loss was 200 (50 - 265) ml. There were no intraoperative complications. 2 (6.4%) patients had post-operative complications. 1 (3.2%) patient had a positive margin. Length of stay was 3.5 (3 - 5) days. Median follow up was 12.5 (7 - 24) months. There were no recurrences. RPN did result in statistically significant changes in renal function 3 months post RPN compared to preoperative renal function, p=0.0001.

CONCLUSION:

RPN is a safe approach for select patients with complex renal tumours and may facilitate tumour resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.