Strategies for success: a multi-institutional study on robot-assisted partial nephrectomy for complex renal lesions.

2018-05

Hennessey, Derek B

Wei, Gavin

Moon, Daniel

Kinnear, Ned J

Bolton, Damien M

Lawrentschuk, Nathan

Chan, Yee K

RENAL score

complex renal tumour

nephron sparing surgery

robotic partial nephrectomy

Journal Article

0000-0002-7833-2537

0000-0002-5145-6783

0000-0002-7372-0100

0000-0001-8553-5618

10.1111/bju.14059

To describe our technique, illustrated with images and videos, of robot-assisted partial nephrectomy (RAPN) for challenging renal tumours. A study of 249 patients who underwent RAPN in multiple institutions was performed. Patients were identified using prospective RAPN databases. Complex renal lesion were defined as those with a RENAL nephrometry score ≥10. Data were analysed and differences among groups examined. A total of 31 (12.4%) RAPNs were performed for complex renal tumours. The median (interquartile range [IQR]) patient age was 57 (50.5-70.5) years and 21 patients (67.7%) were men. The median (IQR) American Society of Anesthesiologists score was 2 (2-3). The median (IQR) operating time was 200 (50-265) min, warm ischaemia time was 23 (18.5-29) min, and estimated blood loss was 200 (50-265) mL. There were no intra-operative complications. Two patients (6.4%) had postoperative complications. One patient (3.2%) had a positive surgical margin. The median (IQR) length of stay was 3.5 (3-5) days and the median (IQR) follow-up was 12.5 (7-24) months. There were no recurrences. RAPN resulted in statistically significant changes in renal function 3 months after RAPN compared with preoperative renal function (P < 0.001). Our results showed that RAPN was a safe approach for selected 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.

link

BJU International 2018; 121 Suppl 3: 40-47

BJU International