Elsevier

Urology

Volume 64, Issue 5, November 2004, Pages 914-918
Urology

Adult urology
Robotic-assisted laparoscopic partial nephrectomy: Technique and initial clinical experience with daVinci robotic system

https://doi.org/10.1016/j.urology.2004.06.049Get rights and content

Abstract

Objectives

To develop and assess the feasibility of laparoscopic partial nephrectomy performed using the daVinci robotic system.

Methods

Between November 2002 and August 2003, 13 patients with solid or suspicious cystic renal masses underwent robotic-assisted laparoscopic partial nephrectomy. In 8 cases, an intra-arterial catheter was inserted for renal cooling before occlusion of the renal artery. The remaining 5 patients underwent partial nephrectomy after the renal hilum had been clamped. Tumor excision and intracorporeal suturing were performed entirely with telerobotics. The perioperative data and pathologic results were retrospectively reviewed.

Results

The mean lesion diameter was 3.5 cm (range 2.0 to 6.0). The mean operative time was 215 minutes (range 130 to 262), and the mean blood loss was 170 mL (range 50 to 300). The mean warm ischemia was 22 minutes (range 15 to 29), and the mean cold ischemia time was 33 minutes (range 18 to 43). The length of hospital stay averaged 4.3 days (range 2 to 7). The resected lesions included renal cell carcinoma in 10, oncocytoma in 2, and a complex renal cyst in 1. In 1 case, a positive margin occurred despite negative frozen sections; laparoscopic nephrectomy was performed and showed no residual tumor. One patient experienced postoperative ileus. At 2 to 11 months of follow-up, no recurrence had been observed.

Conclusions

Robotic-assisted partial nephrectomy is feasible. Robotic partial nephrectomy can be safely performed using a transperitoneal or retroperitoneal approach. A second scrubbed assistant is mandatory to provide assistance using conventional laparoscopic instruments with this technique.

Section snippets

Patients

Between November 2002 and August 2003, 13 patients underwent robotic-assisted transperitoneal or retroperitoneal LPN (Table I). All patients had been evaluated with computed tomography to define the mass clearly preoperatively. The inclusion criteria were solitary, enhancing, predominantly exophytic solid or suspicious cystic renal lesions (Bosniak category III or IV) that were found to be satisfactory candidates for LPN, similar to those indications previously described by Gill et al.12

Results

The patient-related demographic data and results are summarized in Table I. In all cases, LPN was performed on an elective basis in the presence of a normal contralateral kidney. A total of 13 daVinci-assisted LPN procedures were performed, with a mean operative time of 215 minutes (range 130 to 262). The mean operative time included the time required for installation of the robot. In all cases, the initial setup of the robot was performed before initiation of the pneumoperitoneum. Overall, the

Comment

Because intracorporeal suturing is perceived by many urologists as technically difficult and time consuming, a variety of alternative hemostatic techniques have been introduced for LPN.3, 4, 5, 6, 7, 8 However, the alternative techniques have at times been less reliable than what is possible with suture closure of the renal defect. A technique of LPN has also been described using intracorporeal suturing with conventional laparoscopic instruments. This approach is increasingly preferred by

Conclusions

In our initial clinical experience, daVinci-assisted LPN was feasible and was able to recapitulate the steps of open partial nephrectomy and conventional LPN. Robotic-assisted LPN can be safely performed using a transperitoneal or retroperitoneal approach. A second scrubbed surgeon is mandatory for this procedure to provide technical assistance using conventional laparoscopic instruments.

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