Robotic Assisted Laparoscopic Partial Nephrectomy For Suspected Renal Cell Carcinoma

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 10 Nov 2008 - 3:00 PDT

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UroToday.com - Our single center study on robotic partial nephrectomy represents one of the largest series in the world. The study, which shows results comparable, if not better, than most laparoscopic series, is significant for the relatively short ischemic times and excellent pathological outcomes.

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. The robot adds a particular amount of efficiency to the procedure, as rapid sewing, similar to the open approach, is the rule. Thus, ischemic times are shortened, and indeed for exophytic small tumors, <3cm, ischemic times are usually under 20 minutes.

The procedure has been augmented by some modifications to the laparoscopic technique. The renorrhaphy has 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, and most higher volume robotic surgeons have adopted this technique.

The most vocal critics of the procedure have been laparoscopic surgeons stating that robotics is unnecessary. Such is true of any robotic procedure any procedure that can be done robotically can also be done laparoscopically. However, the ease of reconstruction with robotic technology adds a facet which may ultimately show the superiority of the robotic technique.

Caution is advised, however. Certainly not every renal tumor should be treated with a 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.

Written by Sam B. Bhayani, MD, as part of Beyond the Abstract on UroToday.com

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