Review of robot-assisted partial nephrectomy in modern practice

Partial nephrectomy (PN) is currently the standard treatment for T1 renal tumors. Minimally invasive PN offers decreased blood loss, shorter length of stay, rapid convalescence, and improved cosmesis. Due to the challenges inherent in laparoscopic partial nephrectomy, its dissemination has been stifled. Robot-assisted partial nephrectomy (RAPN) offers an intuitive platform to perform minimally invasive PN. It is one of the fastest growing robotic procedures among all surgical subspecialties. RAPN continues to improve upon the oncological and functional outcomes of renal tumor extirpative therapy. Herein, we describe the surgical technique, outcomes, and complications of RAPN.

[1]  Mani Menon,et al.  Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. , 2014, The Journal of urology.

[2]  Andrew J Vickers,et al.  Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. , 2006, The Lancet. Oncology.

[3]  J. Kaouk,et al.  Letters to the Editor/Errata Re: Functional Recovery after Partial Nephrectomy: Effects of Volume Loss and Ischemic Injury , 2012 .

[4]  R. Thompson,et al.  Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis. , 2012, The Journal of urology.

[5]  S. Bhayani,et al.  Surgical outcomes of robot‐assisted partial nephrectomy , 2011, BJU international.

[6]  J. Kaouk,et al.  Robotic laparoendoscopic single-site radical nephrectomy: surgical technique and comparative outcomes. , 2011, European urology.

[7]  M. Makuuchi,et al.  The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience , 2009, Annals of surgery.

[8]  C. Sundaram,et al.  Comparison of measured renal tumor size versus R.E.N.A.L. nephrometry score in predicting patient outcomes after robot-assisted laparoscopic partial nephrectomy. , 2013, Journal of endourology.

[9]  R. Kacker,et al.  Robotic partial nephrectomy versus laparoscopic partial nephrectomy: a single laparoscopic trained surgeon’s experience in the development of a robotic partial nephrectomy program , 2013, World Journal of Urology.

[10]  A. Hemal,et al.  A nonrandomized prospective comparison of robotic-assisted partial nephrectomy in the elderly to a younger cohort: an analysis of 339 patients with intermediate-term follow-up. , 2014, Urology.

[11]  J. D. Del Pizzo,et al.  Current status of robotic partial nephrectomy (RPN) , 2011, BJU international.

[12]  M. Menon,et al.  Robotic partial nephrectomy for renal tumors larger than 4 cm. , 2010, European urology.

[13]  R. Uzzo,et al.  Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. , 2012, The Journal of urology.

[14]  I. Derweesh,et al.  RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak. , 2012, Urology.

[15]  J. Kaouk,et al.  [Robotic partial nephrectomy: five years retrospective analysis at a single center]. , 2013, Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie.

[16]  Mark W. Ball,et al.  Nonmodifiable Factors and Complications Contribute to Length of Stay in Robot-Assisted Partial Nephrectomy , 2015, Journal of endourology.

[17]  I. Gill,et al.  Robotic nephron-sparing surgery for renal tumors: Current status , 2014, Indian journal of urology : IJU : journal of the Urological Society of India.

[18]  A. Hemal,et al.  Does nephrometry scoring of renal tumors predict outcomes in patients selected for robot-assisted partial nephrectomy? , 2011, Journal of endourology.

[19]  A. Cestari,et al.  Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robotassisted partial nephrectomy , 2012 .

[20]  J. McKiernan,et al.  Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach , 2012, BJU international.

[21]  R. Uzzo,et al.  Internal validation of the renal pelvic score: a novel marker of renal pelvic anatomy that predicts urine leak after partial nephrectomy. , 2014, Urology.

[22]  V. Campese,et al.  "Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique. , 2011, European urology.

[23]  P. Pierorazio,et al.  Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. , 2013, The Journal of urology.

[24]  A. Masson-Lecomte,et al.  Early unclamping technique during robot‐assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity , 2014, BJU international.

[25]  J. Kaouk,et al.  Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. , 2011, The Journal of urology.

[26]  J. Kaouk,et al.  Robot-assisted partial nephrectomy in patients with baseline chronic kidney disease: a multi-institutional propensity score-matched analysis. , 2014, European urology.

[27]  J. Lynch,et al.  Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. , 2002, The Journal of urology.

[28]  E. Klein,et al.  Complications of nephron sparing surgery for renal tumors. , 1994, The Journal of urology.

[29]  John T. Wei,et al.  National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? , 2006, Urology.

[30]  Stephen A Boorjian,et al.  Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. , 2008, The Journal of urology.

[31]  M. Menon,et al.  Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis. , 2008, The Journal of urology.

[32]  David C. Miller,et al.  Robot-assisted retroperitoneal partial nephrectomy: technique and perioperative results. , 2011, Journal of endourology.

[33]  J. Kaouk,et al.  Ipsilateral renal function preservation after robot‐assisted partial nephrectomy (RAPN): an objective analysis using mercapto‐acetyltriglycine (MAG3) renal scan data and volumetric assessment , 2015, BJU international.

[34]  Monish Aron,et al.  Robotic and laparoscopic partial nephrectomy: a matched‐pair comparison from a high‐volume centre , 2008, BJU international.

[35]  K. Rha,et al.  Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. , 2015, European urology.

[36]  Tyler R. McClintock,et al.  Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? , 2014, Urology.

[37]  Inderbir S Gill,et al.  Kidney tumor location measurement using the C index method. , 2010, The Journal of urology.

[38]  Mark W. Ball,et al.  Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi‐institutional study , 2015, BJU international.

[39]  J. Kaouk,et al.  Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy , 2012, Patient Safety in Surgery.

[40]  J. Kaouk,et al.  Multi-institutional analysis of robot-assisted partial nephrectomy for renal tumors >4 cm versus ≤ 4 cm in 445 consecutive patients. , 2012, Journal of endourology.

[41]  J. Kaouk,et al.  Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. , 2011, European urology.

[42]  J. Kaouk,et al.  Prospective multi-center study of oncologic outcomes of robot-assisted partial nephrectomy for pT1 renal cell carcinoma , 2012, BMC Urology.

[43]  R. Uzzo,et al.  Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. , 2011, Urology.

[44]  W. Lowrance,et al.  Adult Urology Oncology : Adrenal / Renal / Upper Tract / Bladder Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States , 2022 .

[45]  J. Cheville,et al.  Associations with contralateral recurrence following nephrectomy for renal cell carcinoma using a cohort of 2,352 patients. , 2005, Journal of Urology.

[46]  K. Bensalah,et al.  Predictive factors of complications after robot‐assisted laparoscopic partial nephrectomy: a retrospective multicentre study , 2013, BJU international.

[47]  J. Kaouk,et al.  Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. , 2013, Urology.

[48]  M. Stifelman,et al.  Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. , 2009, The Journal of urology.

[49]  P. Russo,et al.  Renal cell carcinoma: presentation, staging, and surgical treatment. , 2000, Seminars in oncology.

[50]  B. Lane,et al.  7-year oncological outcomes after laparoscopic and open partial nephrectomy. , 2010, The Journal of urology.

[51]  S. Bhayani,et al.  Renal functional and perioperative outcomes of off-clamp versus clamped robot-assisted partial nephrectomy: matched cohort study. , 2012, Urology.

[52]  Masahiko Nakamoto,et al.  Three-dimensional reconstruction of renovascular-tumor anatomy to facilitate zero-ischemia partial nephrectomy. , 2012, European urology.

[53]  C. Kwak,et al.  Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison , 2015, World Journal of Urology.

[54]  V. Janout,et al.  Epidemiology and risk factors of kidney cancer. , 2004, Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia.

[55]  J. Cheville,et al.  Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. , 2004, The Journal of urology.

[56]  J. Kaouk,et al.  30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program? , 2014, The Journal of urology.

[57]  A. Weizer,et al.  Association of RENAL nephrometry score with outcomes of minimally invasive partial nephrectomy , 2013, International journal of urology : official journal of the Japanese Urological Association.

[58]  C. Lohse,et al.  Renal nephrometry score is associated with urine leak after partial nephrectomy , 2011, BJU international.

[59]  Elspeth M McDougall,et al.  Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. , 2008, Journal of endourology.

[60]  P. Pierorazio,et al.  Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. , 2011, Urology.

[61]  S. Horenblas,et al.  Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. , 2011, The Journal of urology.

[62]  Michael Stöckle,et al.  Assessing the impact of ischaemia time during partial nephrectomy. , 2009, European urology.

[63]  A. Goh,et al.  Higher RENAL Nephrometry Score is predictive of longer warm ischemia time and collecting system entry during laparoscopic and robotic-assisted partial nephrectomy. , 2011, Urology.

[64]  J. Kaouk,et al.  Nephrometry score is associated with volume loss and functional recovery after partial nephrectomy. , 2012, The Journal of urology.

[65]  F. Porpiglia,et al.  Laparoscopic versus open partial nephrectomy: analysis of the current literature. , 2008, European urology.

[66]  S. Bhayani,et al.  Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy. , 2010, Journal of endourology.

[67]  Robert G Uzzo,et al.  The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. , 2009, The Journal of urology.

[68]  Jie Cai,et al.  "Trifecta" in partial nephrectomy. , 2013, The Journal of urology.

[69]  J. Kaouk,et al.  Robotic versus laparoscopic partial nephrectomy: single-surgeon matched cohort study of 150 patients. , 2010, Urology.

[70]  Akshay Bhandari,et al.  Maximizing console surgeon independence during robot-assisted renal surgery by using the Fourth Arm and TilePro. , 2009, Journal of endourology.

[71]  J. Kaouk,et al.  Guideline for management of the clinical T1 renal mass. , 2009, The Journal of urology.

[72]  Mark W. Ball,et al.  Perioperative outcomes of robotic partial nephrectomy for intrarenal tumors. , 2015, Journal of endourology.

[73]  S. Bhayani,et al.  Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. , 2009, Urology.

[74]  Inderbir S Gill,et al.  Factors predicting renal functional outcome after partial nephrectomy. , 2007, The Journal of urology.

[75]  Charles E McCulloch,et al.  Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. , 2004, The New England journal of medicine.

[76]  A. Morey.  Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. , 2005, The Journal of urology.

[77]  R. Sylvester,et al.  A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. , 2011, European urology.

[78]  R. Thompson,et al.  Partial versus radical nephrectomy: the debate regarding renal function ends while the survival controversy continues. , 2014, European urology.

[79]  J. Kaouk,et al.  Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. , 2013, European urology.

[80]  Inderbir S Gill,et al.  Every minute counts when the renal hilum is clamped during partial nephrectomy. , 2010, European urology.

[81]  J. Patard,et al.  Are Urologists and Radiologists Equally Effective in Determining the RENAL Nephrometry Score? , 2015, Annals of Surgical Oncology.

[82]  Walter Artibani,et al.  Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. , 2009, European urology.

[83]  Louis R Kavoussi,et al.  Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. , 2007, The Journal of urology.

[84]  I. Gill,et al.  Halving ischemia time during laparoscopic partial nephrectomy. , 2008, The Journal of urology.

[85]  S. Taneja,et al.  National trends in the utilization of partial nephrectomy before and after the establishment of AUA guidelines for the management of renal masses. , 2013, Urology.

[86]  G. Haber,et al.  Laparoscopic partial nephrectomy: contemporary technique and outcomes. , 2006, European urology.

[87]  E. Messing,et al.  Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. , 2014, European urology.