Robot-assisted laparoscopic partial nephrectomy: Contemporary results over a wide range of tumor complexity

Abstract

Background: Partial nephrectomy (PN) is considered the gold standard surgical treatment for renal masses < 7cm in size (T1 tumors). Since the introduction of the robotic-assisted laparoscopic PN (raPN) in high-volume centers, it has been increasingly adapted and standardized by urologists worldwide. There is growing evidence that the robot-assisted laparoscopic technique is associated with superior outcomes compared to those of open and conventional laparoscopic techniques. This study aimed to summarize the contemporary outcome data of raPN for renal tumors with varying degrees of complexity and to assess whether the outcomes reported from high-volume centers are reproducible in a limited caseload setting.

Materials and methods: This was a retrospective study of a single surgeon's experience, including 123 consecutive patients undergoing raPN at our institution. Ultimately, 110 patients were included in the analysis. Basic characteristics, tumor complexity as described by the RENAL score, complications described by the Clavien-Dindo classification system, and functional and oncological outcomes were assessed and analyzed statistically.

Results: Of the 110 patients, 27 (24%), 61 (55%), and 23 (21%) had low, intermediate, and high degrees of complexity, respectively, according to the RENAL score. A cancer-negative surgical margin was achieved in 108 (97%) patients. A total of 70 (64%) patients had no loss of renal function, while 20 (27%) had minimal loss of renal function. Complications of > 3 Clavien-Dindo classification during the first 30 postoperative days occurred in 5 (5%) patients. The 3 complexity groups were found to have significantly different ischemia time: Low, 8 minutes (interquartile range [IQR], 8-9.5); Intermediate, 12 minutes (IQR, 10-13); and High, 15.5 minutes (IQR, 11.25-18.75) (p < 0.001). There were no significant differences between the groups.

Conclusions: Contemporary standards for raPN are safe and reproducible. Adherence to the technique reported by centers of excellence yielded comparable results with regard to tumor control, preservation of renal function, and complication rates in lower-volume settings.

Keywords

Robot-assisted laparoscopic partial nephrectomy / Contemporary results / Standardized technique / Tumor complexity

Acknowledgments

We would like to thank Arbenita Destani for her support with data acquisition.

Statement of ethics

This study complied with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. All patients provided written informed consent, and the Ethical Committee of the Canton of Zurich approved the study protocol.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Funding source

None.

Author contributions

KS, MHU: Statistics;

MHU, MM: Study concept and design;

MHU, SJ, MM: Manuscript writing;

MM: Manuscript review;

SJ, KS, BF, MZ, MM: Manuscript review;

SJ, MHU, BF, MZ: Data acquisition.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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