Society of Robotic Surgery 2017: State-of-the-Art Lecture: Robotics in Renal Surgery, What’s the Next Frontier?

Miami, Florida USA (UroToday.com) Raju Thomas, MD, Tulane University, presented a state-of-the-art lecture highlighting renal surgery. The role of robotics in urologic oncology has confirmed that for most renal masses requiring nephron-sparing surgery, the robotic approach must be considered. The availability of the robot has increased the ability of surgeons to perform partial nephrectomy (PN). Selecting arterial clamping with early unclamping has improved preservation of nephrons while not sacrificing oncologic outcomes. The use of firefly or indocyanine green technology has enabled the identification of the exact extent of tumor/normal parenchymal interface and decreased warm ischemia time. Cryoablation is appropriate in certain small renal masses and in patients with significant comorbidities who are unable to undergo PN. Radiofrequency ablation is an alternative to PN as well, and both techniques can be performed percutaneously by radiologists or laparoscopically by urologists. Fewer probes and tumors smaller than 3 cm are predictors for success. Follow-up with appropriate imaging to document treatment success is important. High-intensity focal ultrasound is being explored, but it is not standardized at present, although centers such as the University of Indiana are examining this option.

Immunologic therapy and angiogenesis-inhibiting drugs have emerged in treating renal tumors. Targeted therapies such as pazopanib in a recent phase III study can be used in advanced or metastatic renal cell carcinoma. Minimally invasive surgical techniques such as radical nephrectomy and PN have become the mainstay in the management of renal masses, and particular robotics have resulted in the increased use of PN.

Presented By: Raju Thomas, MD, Tulane University

Contributed by Stephen B. Williams, MD, Assistant Professor, The University of Texas Medical Branch at Galveston, Galveston, TX

at the 2017 Society of Robotic Surgery - February 24 - 26, 2017 – Miami, Florida USA

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