SAN DIEGO, CA USA (UroToday.com) - The transition from open to robot-assisted partial nephrectomy (RAPN) has been gaining momentum in recent years, with advances in instrumentation and technology.
This retrospective study represents the largest collaborative multi-institutional experience with robot-assisted partial nephrectomy (RAPN) to date, with data collected from 27 high-volume academic institutions.
Specifically, this retrospective review included all consecutive robot-assisted partial nephrectomies from 27 institutions between 2007-2012. Of 33 primary surgeons, approximately 80% of surgeons had received advanced training in minimally-invasive/endourology (76%) or urologic oncology (24%) fellowships. The surgeons had a collective experience of more than 3 000 pure or hand-assisted laparoscopic partial nephrectomies.
The study included data on a total of 2 507 patients that underwent RAPN. The mean patient age was 58.0 years (range 19-89), and 1 490 of these were men (59%). Procedures were performed for tumors in the left kidney in 1 251 patients (49.9%) or right in 1 256 patients (51.1%). The mean operative time was 199.6 minutes (range 52-447 min.) and warm ischemia time was 22.5 minutes (range 5-77 min.). Estimated blood loss was 204 mL (range 5-2800 mL) and the mean hospital stay was 2.6 days (range 1-89 days). The mean tumor size was 2.9 cm (range 0.5-15 cm), and 95.7% of the specimens had negative surgical margins. The mean and median R.E.N.A.L. scores were 6.54 (range 4-12) and 7 (median). The overall postoperative complication rate was 16.0% (n=402), of which 59% were Clavien I and II complications. This is an acceptably low complication rate, equivalent with historical complication rates of open and laparoscopic partial nephrectomy
These authors present, what, is to our knowledge, the largest series to date of RAPN. This series from 27 high-volume robotic centers demonstrates an increasing ability for urologists at these centers to perform complex renal tumors, with high nephrometry scores, and achieve acceptable complication rates. This 5-year study, across several major institutions, has generated significant data demonstrating the advantages and limitations of robotic technology. However, this study is limited by the lack of generalizability of the results, as all surgeons in the study have extensive experience with minimally-invasive partial nephrectomy.
It is vitally important to objectively assess newer techniques in this manner and compare them to previously reported techniques.
Presented by Ravi Munver, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Hackensack University Medical Center, Hackensack, NJ, USA
Reported for UroToday.com by Zhamshid Okhunov, MD, University of California, Irvine, Department of Urology
