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Robotic Partial Nephrectomy

Introduction

Patients selected for robotic radical nephrectomy include those with tumors confined to the kidney, including tumor troubles involving the main kidney vessels.

Description

A robotic radical nephrectomy is performed by making small incisions in the abdomen where the robotic surgical equipment and camera can be inserted. The abdominal cavity is then inflated with carbon dioxide gas to provide space for the manipulation of the surgical equipment and camera to access the cancerous tissues.

Under the command of the robotic surgeon, the blood flow to the cancerous kidney is stopped, allowing the kidney to then be detached from the surrounding tissue. The cancerous kidney is then put in a special bag and taken out of the body through a small incision.

Outcomes

Laparoscopic radical nephrectomy (LRN) is now considered a standard procedure for most patients with renal malignancy who are not eligible for a nephron-sparing procedure. Recent reports have indicated intermediate-term oncologic data for LRN comparable to that for open radical nephrectomy (ORN). Our objective was to present the long-term oncologic and renal function outcomes of LRN compared with a contemporary series of ORN from a single institution.

The medical records of 116 patients undergoing radical nephrectomy for pathologically confirmed renal cell carcinoma before January 2000 were reviewed. Of these 116 patients, 63 underwent LRN and 53 ORN. The oncologic and renal functional data were obtained from the patient charts, radiographic reports, and direct telephone calls to the patients or their families.

The median follow-up was 65 months (range 19 to 92) in the LRN group and 76 months (range 8 to 105) in the ORN group. LRN was successfully completed in all patients without open conversion. The mean tumor size was 5.4 cm in the LRN group and 6.4 cm in the ORN group (P = 0.007). The 5-year overall survival (78% versus 84%, respectively; P = 0.24), cancer-specific survival (91% versus 93%, respectively; P = 0.75), and recurrence-free survival (91% versus 93%, respectively; P = 0.75) rates were similar between the LRN and ORN groups.

At 7 years, the overall survival (72% versus 84%; P = 0.24), cancer-specific survival (91% versus 93%; P = 0.75), and recurrence-free survival (91% versus 93%; P = 0.75) rates were also comparable. No port site recurrence was noted in the laparoscopic group. The long-term renal function outcomes were similar in the LRN and ORN groups, with serum creatinine increasing by 33% and 25%, and the estimated creatinine clearance decreasing by 31% and 23% from baseline, respectively. Chronic renal insufficiency developed in 4% of patients in each group.

Additional information on this subject is available for download from PubMed.

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