Robotic-assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year

To report our surgical technique of robotic-assisted laparoscopic partial nephrectomy (RLPN) for renal tumours of < 7 cm and present their clinical outcomes, as minimally invasive PN is an increasingly viable option for small renal tumours. From July 2005 to December 2006, 20 consecutive patients (mean age 58.2 years, sd 7.9) had RLPN and a follow-up of >= 1 year, all surgery being undertaken by one surgeon. All cases were elective except in one patient with a solitary kidney. We used the three-arm da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in a four-port, transperitoneal approach. Transient vascular occlusion was applied in all cases using a tourniquet technique. The tumour was excised with a 5-mm margin using cold-cut scissors, and the margins were assessed by frozen sections. The specimen was placed in an impervious bag for subsequent removal via the camera port. Under direct vision, we repaired all pelvicalyceal system entries with absorbable sutures. After the entire tumour bed surface was lined with Floseal(TM) (Baxter Healthcare, Deerfield, IL, ISA) the capsule/parenchyma was closed with running suture, reinforced by haemostatic clips. The mean (sd) operative and warm ischaemia times were 82.7 (17.0) and 21.7 (2.4) min, respectively, and the mean estimated blood loss was 189 (32) mL. There were no intraoperative complications or conversion to open surgery. There was also no bleeding after surgery, perinephric haematoma or urinary leakage. The mean (sd) tumour size was 30.2 (2.4) mm, while margins were negative in all cases of malignancy. At the 1-year follow-up there was no local recurrence, renal functional deterioration or late surgical complications. Our RLPN technique is a safe and feasible option for small renal tumours. Reproducible technique and good team co-ordination are pivotal for obtaining good oncological and surgical outcomes.