Robot‐assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy

Nephron‐sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot‐assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3‐D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron‐sparing surgery, specifically robot‐assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally‐invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot‐assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot‐assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot‐assisted partial nephrectomy. In cases with tumor‐attached surface area more than 15 cm², we should consider switching robot‐assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot‐assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot‐assisted partial nephrectomy will be more frequently carried out as a safe, effective and minimally‐invasive nephron‐sparing surgery procedure.     

后腔镜三套管自制套索控制肾血管下肾脏肿瘤切除术

目的：探讨后腔镜下肾脏肿瘤切除术中使用三套管自制套索控制肾血管临床应用的可行性。方法：后腔镜三套管自制套索控制肾血管下行肾脏肿瘤切除术5例。5例患者术前无或仅有轻微腰痛,无肉眼血尿及腰部包块,经肾脏B超、CT、MRI检查明确肾脏肿块。结果：本组5例手术均获得成功。手术时间130～180min,平均145min。术中出血量50～150m1,平均85ml。术后住院时间7～9天,平均为8天。肾周引流管留置5天,无并发症。随访4～12个月,B超、CT检查未见肿瘤复发。结论：后腔镜肾肿瘤切除术具有患者创伤小,出血少,康复快,并发症少等优点,而采用三套管自制套索控制肾血管具有操作简单,干扰少,经济等优点。     

Partial nephrectomy for small children: Robot‐assisted versus open surgery

Objectives

To compare the outcomes of robot‐assisted heminephrectomy for duplex kidney in children with those of open heminephrectomy.

Methods

The present retrospective multicentric analysis reviewed the records of robot‐assisted versus open heminephrectomy carried out for duplex kidney in children from 2007 to 2014. Demographic data, weight, surgical time, hospital stay, complications and outcome were recorded. Follow up was based on a clinical review, renal sonography and dimercaptosuccinic acid renal scintigraphy.

Results

A total of 15 patients underwent robot‐assisted heminephrectomy, and 13 patients underwent retroperitoneal heminephrectomy by open approach. All patients weighed <15 kg. The mean age at the time of surgery was 20.2 months (range 7–39 months) in the robotic group, and 18.4 months (range 6–41 months) in the open group. The mean hospital stay was statistically longer for the open surgery group (6.3 days, range 5–8 days vs 3.4 days, range 1–7 days; P < 0.001). Regarding postoperative pain control, total morphine equivalent intake was statistically greater for the open group (0.52 mg/kg/day vs 1.08 mg/kg/day; P < 0.001). No patient lost the remaining healthy moiety. There was no significant difference in terms of operating time, complication rate or renal outcomes.

Conclusions

Robot‐assisted heminephrectomy in small children seems to offer comparable renal outcomes with those of its standard open surgery counterpart. Specific technical adjustments are necessary, which typically increase the set‐up time.