Robotic partial nephrectomy: surgical technique

• Published in: BJU international Vol. 108; no. 6b; pp. 942 - 947
• Main Authors: Sukumar, Shyam, Rogers, Craig G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011; Wiley Subscription Services, Inc
• Subjects: current outcomes; Humans; Kidney Neoplasms - surgery; laparoscopic partial nephrectomy; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Nephrectomy - adverse effects; Nephrectomy - methods; nephron‐sparing surgery; operative technique; partial nephrectomy; Postoperative Complications - therapy; robotic partial nephrectomy; Robotics; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; Treatment Outcome
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10457.x

What's known on the subject? and What does the study add? Robotic partial nephrectomy has equivalent oncological outcomes, and possibly better functional outcomes in the short‐to‐intermediate term, when compared to laparoscopic partial nephrectomy. Robotic partial nephrectomy has a less prohibitive learning curve, better ergonomics, and improved vision when compared to laparoscopic partial nephrectomy. We describe our standard transperitoneal technique for robotic partial nephrectomy and also highlight the essential steps in an accompanying video. Novel approaches are discussed, including robotic bulldog clamps for hilar clamping, robotic ultrasound probe for tumour identification, flexible Doppler probe for vessel identification, and barbed suture renorrhaphy. Tips and tricks to avoid common pitfalls and manage complications are discussed. •  Kidney sparing approaches have become the ‘gold standard’ for the management of small renal masses and have been shown to be equivalent to radical nephrectomy for oncological outcomes. •  Robotic partial nephrectomy (RPN) has emerged as a feasible alternative to other minimally invasive approaches for patients requiring nephron‐sparing surgery. •  Several reports have highlighted the benefits of RPN, including a less demanding learning curve and shorter warm ischaemia time. •  We describe our operative technique for transperitoneal RPN, discuss contemporary outcomes and suggest tips to avoid complications.