机器人辅助和普通腹腔镜肾部分切除术治疗肾血管平滑肌脂肪瘤的比较

目的对比肾血管平滑肌脂肪瘤（RAML）患者中应用机器人辅助肾部分切除术（RAPN）与普通腹腔镜下肾部分切除术（LPN）的安全性及有效性。 方法收集2016年1月至2021年8月我院收治的肾血管平滑肌脂肪瘤患者198例,其中80例为机器人辅助肾部分切除术组,118例为腹腔镜下肾部分切除术组。采用倾向性评分匹配后分析比较两术式的临床指标。 结果198例患者中有3例术中中转开放（包括2例LPN,1例RAPN）,1例LPN术中损伤输尿管,其余均顺利完成手术。RAPN组术中热缺血时间显著低于LPN组;RAPN组术后血红蛋白（Hb）差值百分比及eGFR差值百分比均显著低于LPN组（P<0.05）;手术时间、术中估计出血量、术中及术后输血率、术后并发症、术后引流量、引流管留置时间、胃肠道功能恢复时间、术后住院时间方面两组差异无统计学意义。 结论在肾血管平滑肌脂肪瘤患者中,应用机器人辅助肾部分切除术相较于普通腹腔镜下肾部分切除术具有显著优势,手术出血更少,热缺血时间更短,能更大程度保留肾功能。     

机器人辅助与腹腔镜肾部分切除术远期生存比较

目的:比较经机器人辅助肾部分切除术(RAPN)与经腹腔镜下肾部分切除术(LPN)的T_1N_0M_0肾癌患者的远期生存。方法:收集2014年1月—2016年8月郑州大学第一附属医院216例经RAPN或LPN治疗的单侧T_1N_0M_0(≤7 cm)肾肿瘤患者的临床、病理以及生存资料。依据手术方式不同分为RAPN组(n=90)与LPN组(n=126)。比较两组患者的临床病理特征以及生存差异,同时研究预后的影响因素。结果:216例肾癌患者的中位随访时间为4.9(2.5～6.4)年。RAPN组患者的年龄、BMI值和肿瘤平均直径均高于LPN组(P0.05),两组总生存率、肿瘤特异生存率及无病生存率比较差异无统计学意义(P0.05),多因素回归分析显示高龄和高Fuhrman分级是肿瘤特异性死亡的独立危险因素(P0.05)。结论:RAPN患者的远期生存良好且与LPN的远期生存无明显差异。     

机器人辅助腹腔镜与腹腔镜肾部分切除术治疗完全内生型肾肿瘤的疗效比较

目的比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗完全内生型肾肿瘤的疗效。方法回顾性分析2015年1月至2021年6月南昌大学第一附属医院行RAPN或LPN的73例完全内生型肾肿瘤患者的临床资料。RAPN组29例, 男21例, 女8例;年龄(48.6±13.7)岁, 肿瘤最大径(2.9±0.9)cm;左侧13例, 右侧16例;R.E.N.A.L.评分(9.2±1.0)分;术前估算肾小球滤过率(eGFR)(82.6±10.7) ml/(min·1.73 m2)。LPN组44例, 男27例, 女17例;年龄(50.1±12.3)岁;肿瘤最大径(2.9±0.9)cm;左侧24例, 右侧20例;R.E.N.A.L.评分(9.1±1.3)分;术前eGFR(81.7±9.6) ml/(min·1.73 m2)。两组术前一般资料差异均无统计学意义(P>0.05)。比较两组手术时间、热缺血时间、术中出血量、术后住院时间、术后并发症及术后3个月eGFR变化情况。结果两组均无中转开放及根治手术病例。RAPN组与LPN组手术时间[140(80, 160) min与150...     

微创技术下肾部分切除术治疗完全内生型肾脏肿瘤的手术要点和临床疗效分析

目的:探讨腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)及机器人辅助腹腔镜肾部分切除术(robot-assisted laparoscopic partial nephrectomy,RAPN)治疗完全内生型肾脏肿瘤的可行性、安全性及临床疗效.方法:回顾性分析2010年1...     

RAPN与LPN治疗孤立肾肾肿瘤的效果比较

目的比较机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗孤立肾肾肿瘤的效果, 并分析患者术后肾功能和远期生存的影响因素。方法回顾性分析2010年11月至2022年1月在解放军总医院行手术治疗的67例孤立肾肾肿瘤患者的临床资料。男48例, 女19例;年龄(58.6±10.1)岁。按照手术方式不同分为RAPN组(43例)和LPN组(24例)。RAPN组较LPN组的R.E.N.A.L.评分更高[(8.7±1.5)分与(7.9±1.7)分, P=0.042], 两组年龄[(57.4±10.2)岁与(60.9±9.8)岁, P=0.185]、体质量指数(BMI)[(25.7±3.5)kg/m2与(25.1±3.6)kg/m2, P=0.518]及术前血肌酐[(102.9±31.6)μmol/L与(102.3±22.4)μmol/L, P=0.930]差异均无统计学意义。12例术中采用低温处理, 其中RAPN组9例(20.9%), LPN组3例(12.5%, P=0.596)。比较两组手术时间、术中热缺血时间、术中失血量、术后禁食时间、围手术期并发症发生率、术后血肌酐等指...     

单中心机器人辅助腹腔镜与腹腔镜肾部分切除术的比较

目的通过对机器人辅助腹腔镜肾部分切除术(RAPN)与腹腔镜肾部分切除术(LPN)治疗局限性肾癌的对比研究,探讨RAPN的优势和应用价值。方法回顾性分析西京医院泌尿外科2013年3月至2015年4月顺利完成RAPN(n=61)和LPN(n=32)患者的临床资料,对各组年龄、体质量指数(BMI)、R.E.N.A.L.评分、手术时间、温缺血时间、出血量、住院时间、术后并发症以及术后随访情况等进行统计学分析。结果总体两组间年龄、BMI、肿瘤直径、温缺血时间差异均无统计学意义(P0.05),R.E.N.A.L.评分RAPN组大于LPN组(P0.05),手术时间、出血量、住院时间RAPN组明显优于LPN组(P0.05);肿瘤直径≤4cm组,RAPN组与LPN组年龄、BMI、肿瘤直径、温缺血时间差异均无统计学意义(P0.05),R.E.N.A.L.评分RAPN组大于LPN组(P0.05),手术时间、出血量、住院时间RAPN组明显优于LPN组(P0.05);RAPN组内根据肿瘤直径分为≤4cm组和4cm组,两组间BMI、出血量、住院时间差异均无统计学意义(P0.05),两组间年龄、R.E.N.A.L.评分、手术时间、温缺血时间有显著性差异(P0.05)。RAPN组术后并发肠梗阻2例,急性脑梗死1例,LPN组急性脑梗死1例(P0.05);RAPN组术后2例复发、转移,其中1例死亡,余均无死亡及疾病进展发生。结论 RAPN是治疗局限性肾癌有效、可行的术式,较LPN有一定优势。     

改良早期松阻断技术用于机器人辅助腹腔镜肾部分切除术的安全性和疗效

目的:探讨改良早期松阻断技术在机器人辅助腹腔镜肾部分切除术(RAPN)中应用的安全性和疗效。方法:回顾性分析2019年1月至2020年8月南昌大学第一附属医院收治的32例在RAPN术中采用改良早期松阻断技术肾肿瘤患者(改良组)的病例资料,男18例,女14例。平均年龄(48.5±11.2)岁。体质指数(23.8±3.7)...     

腹腔镜与机器人辅助腹腔镜保留肾单位手术治疗复杂性肾癌的临床疗效比较

目的:比较腹腔镜保留肾单位手术(LPN)与机器人辅助腹腔镜保留肾单位手术(RAPN)在治疗复杂性肾癌中的临床疗效。方法:回顾性分析我院2015年12月~2016年12月收治入院的74例局限性复杂肾癌患者接受LPN或RAPN的临床资料,比较两种术式在中转开放或根治性肾切率、热缺血时间、手术时间、术中出血量、术后并发症发生率、住院时间等指标上的不同。结果:LPN组共35例,RAPN组共39例,两组术前影像学评估的R.E.N.A.L.评分差异无统计学意义,RAPN组在中转开放或根治性肾切例数(1vs.6)、热缺血时间[(20.4±6.4)min vs.(27.1±8.6)min]、手术时间[(155.7±48.6)min vs.(178.5±59.7)min]、术中出血量[(49.9±21.2)ml vs.(75.7±37.7)ml]方面显著优于LPN组,而在术后并发症发生率、住院时间上则差异均无统计学意义。结论:在治疗复杂性肾癌方面,LPN和RAPN均是安全有效的方法,RAPN的临床疗效优于LPN。     

孤立肾肾肿瘤外科保肾治疗策略的选择及初步探讨

目的:探讨孤立肾肾肿瘤保肾治疗策略的选择。方法:回顾本中心2017年2月—2022年3月收治孤立肾肾肿瘤患者41例,男28例,女13例,年龄59(27～79)岁。其中38例为体检或术后复查中发现,2例患者因血尿就诊,1例患者因腰腹部肿块就诊。肿瘤位于左肾14例,右肾27例,其中肾门部肿瘤2例,肿瘤直径24(8～75) mm。所有患者均在气管插管全麻下进行,其中4例行开放肾部分切除术,19例行腹腔镜肾部分切除术,11例行机器人辅助腹腔镜肾部分切除术,3例行小切口辅助腹腔镜肾部分切除术,4例行腹腔镜肾肿瘤微波消融术。记录手术时间、出血量、肾动脉阻断方式、肾动脉阻断时间、术中及术后并发症、术前及出院前血肌酐值、住院时间。结果:所有手术均安全顺利完成,无术中并发症发生,2例腹腔镜肾部分切除术采用分支动脉阻断,其余肾部分切除术均采用肾动脉主干阻断,腹腔镜肾肿瘤微波消融术均无阻断。2例患者出现术后并发症。开放肾部分切除术组、腹腔镜肾部分切除术组、机器人肾部分切除术组、小切口辅助腹腔镜肾部分切除术组及腹腔镜微波消融组中位手术时间(173 min vs 135 min vs 120 min vs 26...     

腹腔镜下肾部分切除术治疗中心型肾肿瘤是否可行

腹腔镜下肾部分切除术（laparoscopic partial nephrectomy,LPN）作为治疗小肾癌的一项微创术式已经过了约10年的临床实践,已成为大家公认的有效治疗方式。但对于治疗中心型或肾门旁肾肿瘤,由于技术难度的增大,虽然有多项临床观察已报告LPN治疗中心型肾肿瘤可以达到与肾部分切除术（openpartialnephrectomy，OPN）治疗中心型肾肿瘤、LPN治疗外周型肾肿瘤同样好的手术效果和肿瘤学预后，但现阶段LPN治疗中心型肾肿瘤是充满技术性挑战的，需要腹腔镜技术非常熟练的术者才能在较短的热缺血时间内、     

区域NePhRO评分系统在腹腔镜下肾部分切除术治疗T1期肾癌中的应用

目的探讨区域NePhRO评分系统在腹腔镜下肾部分切除术(LPN)治疗T1期肾癌中的临床意义及应用价值。方法2016年5月至2019年12月郑州大学第一附属医院泌尿外科行LPN治疗且术后病理证实为肾癌的T1期肾癌患者98例。根据术前影像资料对患者行区域NePhRO评分,将患者分为低风险组(4~6分)、中风险组(7~9分)、高风险组(10~12分),分析各组间手术时间、热缺血时间、出血量、术后第1天较术前血肌酐变化、围手术并发症等的关系。结果共98例患者纳入研究,低、中、高风险组患者分别为51、34、13例,98例患者均顺利完成手术且切缘均为阴性,术后并发症4例,低风险组2例(1例术后出血经保守治疗好转,1例肺部感染);中等风险组1例(尿漏经积极引流后好转),高风险组1例(术后出血经超选择性介入栓塞治疗)。术后病理:92例为透明细胞癌,4例为乳头状癌,2例嫌色细胞癌。各组在性别(χ²=4.154,P>0.05)、年龄[(50.14±12.04)岁比(53.44±15.59)岁比(52.46±12.05)岁,F=0.653,P>0.05]、BMI[(26.14±2.38)kg/m²比(25.02±2.62)kg/m²比(25.87±2.66)kg/m²,F=2.079,P>0.05]、出血量[(68.04±47.16)ml比(84.71±59.61)ml比(103.08±80.04)ml,F=2.293,P>0.05]、术后住院天数[(7.29±1.10)d比(7.76±1.37)d比(7.92±1.70)d,F=2.021,P>0.05)]差异无统计学意义,在手术时间[(101.57±22.09)min比(107.53±20.34)min比(141.85±33.48)min,F=15.593,P<0.05]、热缺血时间[(18.78±4.97)min比(20.74±5.38)min比(22.46±5.47)min,F=3.208,P<0.05]、血肌酐变化[(6.19±7.96)比(15.21±9.92)比(17.69±9.60),F=14.892,P<0.05]差异有统计学意义。结论不同分级的肾肿瘤在手术时间、热缺血时间、血肌酐变化等重要的手术和功能参数有明显差异。     

Cost-effectiveness of robot-assisted partial nephrectomy for the prevention of perioperative complications

Purpose

To evaluate the cost-effectiveness of robot-assisted partial nephrectomy (RAPN) and secondarily of laparoscopic PN (LPN) compared to the open procedure.

Methods

Model-based cost-effectiveness analysis: The model was structured as decision tree. The model was populated with published data. We measured intraoperative, postoperative complications, and inhospital deaths. We expressed costs in US dollars ($).The reference analysis calculated the mean cost and the mean number of each endpoint over 5000 iterations using a second-order Monte Carlo simulation. We conducted extensive sensitivity analyses.

Results

The mean inhospital costs were $13,186 for RAPN, $10,782 for LPN, and $12,539 for open partial nephrectomy (OPN), respectively. The incremental cost to prevent an inhospital event amounted to $5005 for RAPN compared to OPN. Lower RENAL scores were associated with lower incremental cost per avoided complications. Under assumption of 55 % higher costs in patients with complications, RAPN dominated OPN. LPN dominated OPN. We are aware of the following limitations: First, cost data for patients with and without complications were not available and we assumed the median cost for all cases, i.e., the analysis overestimated the cost associated with RAPN; second, we focused on inhospital estimates and did not apply a societal perspective.

Conclusions

RAPN appears to be a cost-effective mean to avoid inhospital complications; however, these results might not apply to low-volume hospitals or to other health care systems.

     

Comparing the outcomes of open,laparoscopic and robot-assisted partial nephrectomy: a network meta-analysis

Objective

To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomy (RAPN) with particular attention to intraoperative, immediate postoperative, as well as longer-term functional and oncological outcomes.

Methods

A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-NMA guidelines. Binary data were compared using odds ratios (ORs). Mean differences (MDs) were used for continuous variables. ORs and MDs were extracted from the articles to compare the efficacy of the various surgical approaches. Statistical validity is guaranteed when the 95% credible interval does not include 1.

Results

In total, there were 31 studies included in the NMA with a combined 7869 patients. Of these, 33.7% (2651/7869) underwent OPN, 20.8% (1636/7869) LPN, and 45.5% (3582/7689) RAPN. There was no difference for either LPN or RAPN as compared to OPN in ischaemia time, intraoperative complications, positive surgical margins, operative time or trifecta rate. The estimated blood loss (EBL), postoperative complications and length of stay were all significantly reduced in RAPN when compared with OPN. The outcomes of RAPN and LPN were largely similar except the significantly reduced EBL in RAPN.

Conclusion

This systematic review and NMA suggests that RAPN is the preferable operative approach for patients undergoing surgery for lower-staged RCC.     

Necessity of ureteral catheter during laparoscopic partial nephrectomy

PURPOSE: Laparoscopic partial nephrectomy (LPN) is a relatively recently introduced method of treating renal tumors and, as such, surgical technique is evolving. In open series urinary fistula formation represents a common postoperative complication. In the laparoscopic approach investigators have advocated the placement of a ureteral catheter with retrograde dye injection to visualize caliceal entry to aid in closure. In this study we assessed the necessity of ureteral catheter placement during LPN in decreasing urinary leakage. MATERIALS AND METHODS: From February 1998 until November 2002 laparoscopic partial nephrectomy was performed in 103 patients with renal tumors. The patients were assessed retrospectively and divided into 2 groups according to placement (group 1) or no placement (group 2) of an external ureteral catheter. Group 1 included 54 patients (mean age +/- SD 57.4 +/- 13.4 years) and group 2 included 49 patients (mean age +/- SD 57.5 +/- 10.9). Intraoperative and postoperative parameters including blood loss, operative time, ischemia time, mass size, complications and hospital stay were reviewed and compared between the 2 groups. RESULTS: There were no differences between the 2 groups in mean estimated blood loss (group 1, 394.7 cc vs group 2, 291.5 cc, p = 0.07), postoperative serum creatinine (group 1, 0.95 mg/dl vs group 2, 0.89 mg/dl, p = 0.12), requirement for pain medication (group 1, 8.9 mg vs group 2, 4.9 mg morphine equivalents, p = 0.12), hospital stay (group 1, 3.1 vs group 2, 2.9, p = 0.29) and warm ischemia time (group 1, 28 minutes vs group 2, 26.5 minutes, p = 0.18). Mean total operative time was significantly longer for group 1 compared to group 2 (191.1 vs 149.4 minutes, respectively, p = 0.001). Postoperative urinary leakage requiring prolonged drainage occurred in 1 patient in group 1 and 1 in group 2. In both cases caliceal entry was identified and sutured. CONCLUSIONS: With experience caliceal entry can be identified without the need for a ureteral catheter in patients undergoing LPN for a tumor less than 4.5 cm. Urinary fistula may occur despite caliceal entry and repair. A ureteral catheter may not decrease urinary fistula in patients undergoing LPN.     

Comparison of surgical outcomes and split renal function between laparoscopic and robot-assisted partial nephrectomy: a propensity score-matched analysis

Purpose

The objective of this study was to compare perioperative outcomes and total and split renal function between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Predictive risk factors of preservation of operated renal function were also assessed.

Methods

We retrospectively analyzed 173 patients who underwent LPN (n?=?84) or RAPN (n?=?89) between 2010 and 2020. After propensity score matching (1:1), perioperative outcomes and total and split renal function were assessed. Logistic regression analysis was used to evaluate predictive risk factors of preservation of operated renal function. Trifecta criteria were defined as negative surgical margins, warm ischemia time (WIT)?<?25 min, and no complications more than Clavien–Dindo grade II within 4 weeks after surgery. Split renal function was evaluated by mercaptoacetyltriglycine renal scan.

Results

After propensity score matching, 42 patients were allocated to each group. RAPN was associated with significantly shorter WIT (RAPN vs LPN: 12 vs 22 min; p?<?0.0001) and higher trifecta achievement rate (93.3 vs 64.2%; p?<?0.0001). Other perioperative outcomes and total and split renal function were not significantly different between LPN and RAPN. The R.E.N.A.L. nephrometry score (RNS) was a predictive risk factor of preservation of operated renal function in the multivariable logistic regression analysis (odds ratio 1.68, 95% confidence interval 1.29–2.20, p?<?0.0001).

Conclusions

RAPN improved WIT and trifecta achievement rate, but it did not improve the preservation of operated renal function, for which RNS was found to be a strong predictive risk factor.

     

"Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique

Background

Ischemic injury impacts renal function outcomes following partial nephrectomy. Efforts to minimize, better yet, eliminate renal ischemia are imperative.

Objective

Describe a novel technique of “zero ischemia” laparoscopic (LPN) and robotic-assisted (RAPN) partial nephrectomy.

Design, setting, and participants

Data were prospectively collected into an institutional review board–approved database. Fifteen consecutive patients underwent zero ischemia procedures: LPN (n = 12), RAPN (n = 3). Included were all candidates for LPN or RAPN, irrespective of tumor complexity, including tumors that were central (n = 9; 60%), hilar (n = 1), in solitary kidney (n = 1), in patients with chronic kidney disease grade 3 or greater (n = 3). Anesthesia-related monitoring included pulmonary artery catheter (ie, Swan–Ganz), transesophageal echocardiography, cerebral oximetry, electroencephalographic bispectral index, mixed venous oxygen measurements, and vigorous hydration/diuresis. Pharmacologically induced hypotension was carefully timed to correspond with excision of the deepest aspect of the tumor. Renal parenchymal reconstruction was completed under normotension, ensuring complete hemostasis.

Measurements

Intraoperative and early postoperative data were collected prospectively.

Results and limitations

All cases were successfully completed without hilar clamping. Ischemia time was zero in all cases. Median tumor size was 2.5 cm (range: 1–4); operative time was 3 h (range: 1.3–6); blood loss was 150 ml (range: 20–400); and hospital stay was 3 d (range: 2–19). Nadir mean arterial pressure ranged from 52–65 mm Hg (median: 60), typically for 1–5 min. No patient had intraoperative transfusion or complication, acute or delayed renal hemorrhage, or hypotension-related sequelae. Postoperative complications (n = 5) included urine retention (n = 1), septicemia from presumed prostatitis (n = 1), atrial fibrillation (n = 1), urine leak (n = 2). Pathology confirmed renal cell carcinoma in 13 patients (87%), all with negative margins. Median pre- and postoperative serum creatinine (0.9 mg/dl and 0.95 mg/dl, respectively) and estimated glomerular filtration rate (eGFR) (75.3 and 72.9, respectively) were comparable. Median absolute and percent change in discharge serum creatinine and eGFR were 0 and 0%, respectively.

Conclusions

A novel zero ischemia technique for RAPN and LPN for substantial renal tumors is presented. The initial experience is encouraging.     

腹腔镜与开放性肾部分切除术治疗小肾癌的安全性与疗效分析

目的 比较腹腔镜与开放性肾部分切除术治疗小肾癌的安全性与近期治疗效果.方法 2004年1月至2009年3月T1aN0M0的肾癌患者110例,均接受肾部分切除术,其中腹腔镜肾部分切除术(LPN)52例(LPN组),开放性肾部分切除术(OPN)58例(OPN组).评估患者的手术时间、肾动脉阻断时间、手术并发症、术后恢复和手术切缘情况.结果 LPN组和OPN组的平均手术时间分别为177.8和126.7 min(P<0.01),肾动脉阻断时间分别为28.3和21.9 min(P>0.05);两组各有2例(3.8%)和1例(1.7%)需要输血(P>0.05);手术前后肌苷变化两组差异无统计学意义(P>0.05);两组分别有6例(11.5%)和8例(13.8%)需缝合集合系统(P>0.05);分别有6例(11.5%)和8例(13.8%)术后出现血尿(P>0.05);未出现尿瘘或其他严重的并发症.患者的手术切缘均为阴性.两组患者平均术后住院天数差异有统计学意义(P<0.01).结论 LPN的安全性和治疗效果与OPN相同,但术后恢复快于OPN.对于经选择的患者和有丰富经验的医师,可以考虑将LPN作为治疗T1aN0M0肾癌的首选术式.     

Off-clamp robot-assisted partial nephrectomy: initial washington university experience

Abstract Background and Purpose: Because of the impact warm ischemia time may have on renal function, various surgical techniques have been proposed to minimize or eliminate warm ischemia. The purpose of this study is to evaluate our initial renal functional outcomes of off-clamp robot-assisted partial nephrectomy (RAPN), while assessing the safety profile of this unconventional surgical approach. Patients and Methods: We performed a retrospective review of our off-clamp RAPN experience between August 2007 and January 2012. All patients with baseline and postoperative serum creatinine determinations were included. Patient demographics, operative information, perioperative outcomes, and renal functional outcomes were evaluated for this cohort. Results: Forty-two patients with a mean age of 59.9 years (standard deviation [SD]=12) had a median follow-up of 100 days (range 1-1007 days). In all cases, warm ischemia time was 0 minutes. Mean operative time was 143 minutes (SD=59), and median estimated blood loss was 138?mL (range 50-1500?mL). No intraoperative complications were encountered, and all surgical margins were negative. Our postoperative complication rate was 14.3%. At the most recent follow-up, the mean estimated glomerular filtration rate (eGFR) was 76.2?mL/min/1.73?m(2) (SD=27.6), compared with 78.5?mL/min/1.73?m(2) (SD=28.9) preoperatively (P=0.11). Therefore, the mean eGFR decline of 2.3?mL/min/1.73?m(2) (SD=9.1) was not significant. Conclusions: Off-clamp RAPN is associated with minimal morbidity and minimal decline in renal function on short-term follow-up. Further studies and continued monitoring of renal function are needed to determine if off-clamp RAPN provides any advantage in renal function preservation relative to the traditional RAPN with vascular clamping.     

Robot-assisted partial nephrectomy: current status, techniques, and future directions

Open partial nephrectomy for the treatment of small renal masses (SRMs) concerning for renal cell carcinoma has been increasingly utilized with the increased incidental detection of SRMs and the growing recognition of the benefits of renal preservation. Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that achieves comparable oncologic and improved morbidity outcomes when compared to the open procedure. However, LPN is a technically demanding procedure resulting in a long learning curve and a lack of widespread adoption. Robot-assisted partial nephrectomy (RAPN) overcomes many of the technical hurdles of the LPN and is now coming to the forefront for the minimally invasive surgical management of SRMs. To date, the short-term oncologic outcomes of RAPN have been comparable to the open operation while providing the improved morbidity outcomes of LPN. Although encouraging, we await the long-term oncologic results of this new and promising procedure. The current bottleneck is an issue of cost and reliance on a patient-side surgeon. Future developments in instrumentation, newer robots, cost reduction, more streamlined training, increased robotic experience, and adoption by more centers will lead to greater benefit for patients with SRMs requiring nephron-sparing surgery. This review will discuss techniques for RAPN and then delve into the current status of RAPN using parameters such as warm ischemia time, blood loss, hospital stay, oncological outcomes, complications, learning curve, and quality of life. There will be an exploration of potential disadvantages associated with RAPN followed by a look at evolving techniques in regard to this groundbreaking procedure.