Robotic Partial Nephrectomy Shows Excellent Outcomes

A new study of robotic partial nephrectomy (RPN) shows results that are comparable, if not better, than most traditional laparoscopic procedures.

Researchers at Washington University School of Medicine (Saint Louis, MO, USA) examined and reviewed the patient records and databases of 35 consecutive patients who underwent RPN for suspected renal cell carcinoma, and obtained clinical, pathological, and radiographic data. The study results showed that all 35 patients successfully underwent RPN, while an additional two patients were converted to other nephron sparing procedures. The mean tumor size was 2.8 centimeters in diameter, and mean operating room time was 142 minutes. The mean warm ischemia time was 20 minutes. All margins were negative. There were four complications, and no patients required a return operation. The researchers added that thanks to the new technique, ischemic times are shortened, and that for exophytic small tumors ischemic times are usually under 20 minutes.

The Washington University RPN involves robotic assistance, rapid closure of the collecting system, and renal trauma surgery (renorrhaphy) with sliding nonabsorbable clips; bolsters are rarely used. The procedure evolved from traditional laparoscopic renorrhaphy to a surgeon controlled sliding clip renorrhaphy, which has resulted in added efficiency and tighter closure. The Washington University renorrhaphy is reproducible, resulting in many higher volume robotic surgeons adopting the technique. The researchers preach caution, however, stressing that not every renal tumor should be treated with the same singular technology. In the current era, there is a role for open partial nephrectomy, minimally invasive partial nephrectomy, ablation, and expectant management. Distinguishing amongst these techniques is a challenge, as several patients can do well with any number of modalities. The study was published in the September 24, 2008, edition of BMC Surgery, a publication of Biomed Central.

"Ultimately, the goal of robotic partial nephrectomy is similar to the open counterpart: to provide excellent cancer control with preservation of long-term renal functional outcomes,” concluded co-author Sam Bhayani, M.D., of the department of surgery. "The robot adds a particular amount of efficiency to the procedure, as rapid sewing, similar to the open approach, is the rule.”

Related Links:
Washington University School of Medicine
Biomed Central