87 Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 42 cases

Theaim ofthis study was to evaluate outcomes ofrobotic partial nephrectomy(RAPN) procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L.) nephrometry and PADUA scores of patients were calcu- lated by computed tomography (CT) or magnetic resonance imaging (MRI). Intra- and periopera- tive (0e30 days) complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 � 6.5 years. Mean tumor size was 3.1 � 1.0 (1.4e6.6) cm. R.E.N.A.L. nephrometryand PADUAscoreswere 6.0 � 1.5 and 7.5 � 0.9,respectively. Meansurgical timewas 127.7 � 18.7 minutes and estimated blood loss was 100 � 18.1 cc. Mean warm ischemia time was 16.0 � 8.9 (0e30) minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2e6) days. Except for 17 patients, hilar clamping was performed in 25 pa- tients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell). Oncocytoma (n Z 4), adenoma (n Z 1), fibroadipose tissue (n Z 1), papillary epithelial hyperplasia (n Z 1), and chronic pyelonephritis (n Z 1) were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 � 10.9 (3e46) months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPNisa safe,minimallyinvasivesurgical approach, withexcellentsurgicalandonco- logical outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia. Copyright a 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).