Robot-Assisted Partial Nephrectomy

The incidence of incidentally discovered small renal masses has increased over the last several years. Management of these tumors has shifted from radical to partial nephrectomy and from open surgery to minimally invasive surgery-specifically robotic partial nephrectomy. Robotic partial nephrectomy has proven oncologically equivalent to open partial nephrectomy with decreased blood loss, while proving superior to laparoscopic partial nephrectomy in terms of ischemia time and procedureal conversion to an open surgery or nephrectomy. With robotic partial nephrectomy, the learning curve ranges from 15 to 30 surgeries and both a transperitoneal and retroperitoneal approach may be made depending on tumor characteristics and surgeon comfort. In this chapter, we describe the indications for, operative steps of, outcomes, and complication management for robotic-assisted laparoscopic partial nephrectomy from both a trans- and retroperitoneal approach.