Skip to main content

Advertisement

SpringerLink
Log in

Current Status of Robot-Assisted Partial Nephrectomy

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The incidence of incidentally diagnosed small renal masses is rising. Although open partial nephrectomy (OPN) remains the reference standard for clinically localized renal lesions, growing experience with minimally invasive PN has demonstrated equivalent oncologic efficacy and improved short-term perioperative outcomes compared to open techniques. Compared to the technically demanding laparoscopic PN (LPN), robotic PN (RPN) overcomes a number of the technical hurdles of LPN with a shorter learning curve, and now has emerged as an attractive minimally invasive treatment option for amenable tumors. Although experience with RPN has been limited to date, early series have demonstrated short-term oncologic outcomes comparable to OPN and equivalent perioperative outcomes to LPN (all ≤ level III evidence). Although prospective evidence would be ideal, clinical trial comparisons with LPN and OPN will be fraught with accrual challenges and are not expected in the near future. This review summarizes the advantages and indications for a robotic approach, operative principles and emerging technologies, early functional and oncologic outcomes, and expected future advances of RPN for localized renal tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277.

    Article  PubMed  Google Scholar 

  2. Kane CJ, Mallin K, Ritchey J, et al. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer. 2008;113:78.

    Article  PubMed  Google Scholar 

  3. Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98:1331.

    Article  PubMed  Google Scholar 

  4. Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma–a meta-analysis and review. J Urol. 2008;179:1227.

    Article  PubMed  Google Scholar 

  5. Hollenbeck BK, Taub DA, Miller DC, et al. National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology. 2006;67:254.

    Article  PubMed  Google Scholar 

  6. Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735.

    Article  PubMed  Google Scholar 

  7. McKiernan J, Simmons R, Katz J, et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002;59:816.

    Article  PubMed  Google Scholar 

  8. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296.

    Article  PubMed  CAS  Google Scholar 

  9. •• Huang WC, Elkin EB, Levey AS, et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181:55. Using linked Surveillance, Epidemiology and End Results (SEER)–Medicare data, the authors demonstrate that radical nephrectomy is associated with an increased risk of overall mortality and a greater number of cardiovascular events when compared to partial nephrectomy renal masses smaller than 4 cm.

    Article  PubMed  Google Scholar 

  10. Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179:468.

    Article  PubMed  Google Scholar 

  11. Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178:41.

    Article  PubMed  Google Scholar 

  12. Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59:543.

    Article  PubMed  Google Scholar 

  13. Miller DC, Hollingsworth JM, Hafez KS, et al. Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol. 2006;175:853.

    Article  PubMed  CAS  Google Scholar 

  14. •• Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182:1271. This systematic review performed by the American Urological Association guidelines committee summarizes existing survival, oncologic, and complications data and provides general recommendations for the management of clinically localized stage I renal masses.

    Article  PubMed  Google Scholar 

  15. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163:442.

    Article  PubMed  CAS  Google Scholar 

  16. Abbou CC, Hoznek A, Salomon L, et al. [Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case]. Prog Urol. 2000;10:520.

    PubMed  CAS  Google Scholar 

  17. Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007;110:1951.

    Article  PubMed  Google Scholar 

  18. • Benway BM, Bhayani SB, Rogers CG, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol. 2009;182:866. This multi-institutional comparison of perioperative outcomes following laparoscopic versus robotic partial nephrectomy demonstrates that robotic partial nephrectomy provides equivalent early oncological outcomes, decreased hospital stay, decreased blood loss, and decreased warm ischemia time when compared to laparoscopic partial nephrectomy.

    Article  PubMed  Google Scholar 

  19. Gautam G, Benway BM, Bhayani SB, et al. Robot-assisted partial nephrectomy: current perspectives and future prospects. Urology. 2009;74:735.

    Article  PubMed  Google Scholar 

  20. Winfield HN, Donovan JF, Godet AS, et al. Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol. 1993;7:521.

    Article  PubMed  CAS  Google Scholar 

  21. McDougall EM, Clayman RV, Chandhoke PS, et al. Laparoscopic partial nephrectomy in the pig model. J Urol. 1993;149:1633.

    PubMed  CAS  Google Scholar 

  22. Gill IS, Delworth MG, Munch LC. Laparoscopic retroperitoneal partial nephrectomy. J Urol. 1994;152:1539.

    PubMed  CAS  Google Scholar 

  23. Lane BR, Gill IS. 5-Year outcomes of laparoscopic partial nephrectomy. J Urol. 2007;177:70.

    Article  PubMed  Google Scholar 

  24. Miller DC, Daignault S, Wolf Jr JS, et al. Hospital characteristics and use of innovative surgical therapies among patients with kidney cancer. Med Care. 2008;46:372.

    Article  PubMed  Google Scholar 

  25. Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55:1037.

    Article  PubMed  Google Scholar 

  26. Haseebuddin M, Benway BM, Cabello JM, et al. Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol. 2010;24:57.

    Article  PubMed  Google Scholar 

  27. Mottrie A, De Naeyer G, Schatteman P, et al. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol. 2010;58:127.

    Article  PubMed  Google Scholar 

  28. Mir SA, Cadeddu JA, Sleeper JP, et al. Cost comparison of robotic, laparoscopic, and open partial nephrectomy. J Endourol. 2011;25:447.

    Article  PubMed  Google Scholar 

  29. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001;166:6.

    Article  PubMed  CAS  Google Scholar 

  30. Naeem N, Petros F, Sukumar S, et al. Robot-assisted partial nephrectomy in obese patients. J Endourol. 2011;25:101.

    Article  PubMed  Google Scholar 

  31. Petros FG, Patel MN, Kheterpal E, et al. Robotic partial nephrectomy in the setting of prior abdominal surgery. BJU Int. 2010.

  32. Dulabon LM, Kaouk JH, Haber GP, et al. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol. 2011;59:325.

    Article  PubMed  Google Scholar 

  33. Lebed B, Jani SD, Kutikov A, et al. Renal masses herniating into the hilum: technical considerations of the “ball-valve phenomenon” during nephron-sparing surgery. Urology. 2010;75:707.

    Article  PubMed  Google Scholar 

  34. Rogers CG, Metwalli A, Blatt AM, et al. Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis. J Urol. 2008;180:2353.

    Article  PubMed  Google Scholar 

  35. Gupta GN, Boris R, Chung P, et al. Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up. Urol Oncol. (in press), 2011.

  36. Patel MN, Krane LS, Bhandari A, et al. Robotic partial nephrectomy for renal tumors larger than 4 cm. Eur Urol. 2010;57:310.

    Article  PubMed  Google Scholar 

  37. Rogers CG, Singh A, Blatt AM, et al. Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol. 2008;53:514.

    Article  PubMed  Google Scholar 

  38. Boris R, Proano M, Linehan WM, et al. Initial experience with robot assisted partial nephrectomy for multiple renal masses. J Urol. 2009;182:1280.

    Article  PubMed  Google Scholar 

  39. Touijer K, Jacqmin D, Kavoussi LR, et al. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol. 2010;57:214.

    Article  PubMed  Google Scholar 

  40. Patel MN, Bhandari M, Menon M, et al. Robotic-assisted partial nephrectomy. BJU Int. 2009;103:1296.

    Article  PubMed  Google Scholar 

  41. Rogers CG, Laungani R, Bhandari A, et al. Maximizing console surgeon independence during robot-assisted renal surgery by using the Fourth Arm and TilePro. J Endourol. 2009;23:115.

    Article  PubMed  Google Scholar 

  42. Aron M, Koenig P, Kaouk JH, et al. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre. BJU Int. 2008;102:86.

    Article  PubMed  Google Scholar 

  43. Ghani KR, Anderson C. Closing the deal: renorrhaphy during laparoscopic and robotic partial nephrectomy. BJU Int. 2011;108:2.

    Article  PubMed  Google Scholar 

  44. Benway BM, Wang AJ, Cabello JM, et al. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol. 2009;55:592.

    Article  PubMed  Google Scholar 

  45. Sammon J, Petros F, Sukumar S, et al. Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol. 2011;25:529.

    Article  PubMed  Google Scholar 

  46. Gettman MT, Blute ML, Chow GK, et al. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology. 2004;64:914.

    Article  PubMed  Google Scholar 

  47. Caruso RP, Phillips CK, Kau E, et al. Robot assisted laparoscopic partial nephrectomy: initial experience. J Urol. 2006;176:36.

    Article  PubMed  Google Scholar 

  48. Ho H, Schwentner C, Neururer R, et al. Robotic-assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year. BJU Int. 2009;103:663.

    Article  PubMed  Google Scholar 

  49. Kural AR, Atug F, Tufek I, et al. Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: comparison of outcomes. J Endourol. 2009;23:1491.

    Article  PubMed  Google Scholar 

  50. Michli EE, Parra RO. Robotic-assisted laparoscopic partial nephrectomy: initial clinical experience. Urology. 2009;73:302.

    Article  PubMed  Google Scholar 

  51. Alleemudder A, Dudderidge T. Raj Rao A, et al: Feasibility of robotic partial nephrectomy in a UK Cancer Centre. Br J Med Surg Urol. 2011;4:78.

    Article  Google Scholar 

  52. Gong Y, Du C, Josephson DY, et al. Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol. 2010;28:111.

    Article  PubMed  CAS  Google Scholar 

  53. Scoll BJ, Uzzo RG, Chen DY, et al. Robot-assisted partial nephrectomy: a large single-institutional experience. Urology. 2010;75:1328.

    Article  PubMed  Google Scholar 

  54. White MA, Haber GP, Autorino R, et al. Outcomes of robotic partial nephrectomy for renal masses with nephrometry score of >/=7. Urology. 2011;77:809.

    Article  PubMed  Google Scholar 

  55. Wang AJ, Bhayani SB. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. Urology. 2009;73:306.

    Article  PubMed  Google Scholar 

  56. Deane LA, Lee HJ, Box GN, et al. Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. J Endourol. 2008;22:947.

    Article  PubMed  Google Scholar 

  57. Jeong W, Park SY, Lorenzo EI, et al. Laparoscopic partial nephrectomy versus robot-assisted laparoscopic partial nephrectomy. J Endourol. 2009;23:1457.

    Article  PubMed  Google Scholar 

  58. Haber GP, White WM, Crouzet S, et al. Robotic versus laparoscopic partial nephrectomy: single-surgeon matched cohort study of 150 patients. Urology. 2010;76:754.

    Article  PubMed  Google Scholar 

  59. DeLong JM, Shapiro O, Moinzadeh A. Comparison of laparoscopic versus robotic assisted partial nephrectomy: one surgeon’s initial experience. Can J Urol. 2010;17:5207.

    PubMed  Google Scholar 

  60. Seo IY, Choi H, Boldbaatr Y, et al. Operative outcomes of robotic partial nephrectomy: a comparison with conventional laparoscopic partial nephrectomy. Korean J Urol. 2011;52:279.

    Article  PubMed  Google Scholar 

  61. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56:786.

    Article  PubMed  Google Scholar 

  62. Simmons MN, Ching CB, Samplaski MK, et al. Kidney tumor location measurement using the C index method. J Urol. 2010;183:1708.

    Article  PubMed  Google Scholar 

  63. • Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182:844. The authors introduce a novel scoring system to objectively characterize renal mass anatomy using five critical and reproducible anatomical features to provide a tool to standardize classification of renal masses for the effective comparison of case mix.

    Article  PubMed  Google Scholar 

  64. Kutikov A, Smaldone MC, Egleston BL, et al. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol. 2011;60:241.

    Article  PubMed  Google Scholar 

  65. Canter D, Kutikov A, Manley BJ, et al. Utility of the R.E.N.A.L.-nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. Urology. (in press), 2011.

  66. Hayn MH, Schwaab T, Underwood W, et al. RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy. BJU Int. (in press), 2010.

  67. Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol. (in press), 2011.

  68. Simhan J, Uzzo RG, Kutikov A, et al. A nephrometry based comparative analysis of robotic and open partial nephrectomy for moderate and complex renal tumors. (presented at the Society of Urologic Oncology annual meeting, Besthesda, MD), 2010.

  69. Kaul S, Laungani R, Sarle R, et al. da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Eur Urol. 2007;51:186.

    Article  PubMed  Google Scholar 

  70. Benway BM, Bhayani SB, Rogers CG, et al. Robot-assisted partial nephrectomy: an international experience. Eur Urol. 2010;57:815.

    Article  PubMed  Google Scholar 

  71. • Spana G, Haber GP, Dulabon LM, et al. Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. J Urol. 2011. In this multi-institutional experience summarizing postoperative complications following robotic partial nephrectomy, the authors demonstrate that robotic partial nephrectomy is safe compared to contemporary procedures and report that most ensuing complications were low grade.

  72. Thompson RH, Lane BR, Lohse CM, et al. Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol. 2010;58:331.

    Article  PubMed  Google Scholar 

  73. Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58:340.

    Article  PubMed  Google Scholar 

  74. Lane BR, Russo P, Uzzo RG, et al. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J Urol. 2011;185:421.

    Article  PubMed  Google Scholar 

  75. Simmons MN, Schreiber MJ, Gill IS. Surgical renal ischemia: a contemporary overview. J Urol. 2008;180:19.

    Article  PubMed  Google Scholar 

  76. Abaza R, Picard J. A novel technique for laparoscopic or robotic partial nephrectomy: feasibility study. J Endourol. 2008;22:1715.

    Article  PubMed  Google Scholar 

  77. Nguyen MM, Gill IS. Halving ischemia time during laparoscopic partial nephrectomy. J Urol. 2008;179:627.

    Article  PubMed  Google Scholar 

  78. Gill IS, Kamoi K, Aron M, et al. 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol. 2010;183:34.

    Article  PubMed  Google Scholar 

  79. Brandina R, Gill IS. Robotic partial nephrectomy: new beginnings. Eur Urol. 2010;57:778.

    Article  PubMed  Google Scholar 

  80. Piotrowski Z, Canter DJ, Kutikov A, et al. Metanephric adenofibroma: robotic partial nephrectomy of a large Wilms’ tumor variant. Can J Urol. 2010;17:5309.

    PubMed  Google Scholar 

  81. Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. 2010;183:473.

    Article  PubMed  Google Scholar 

  82. Viprakasit DP, Altamar HO, Miller NL, et al. Selective renal parenchymal clamping in robotic partial nephrectomy: initial experience. Urology. 2010;76:750.

    Article  PubMed  Google Scholar 

  83. Gill IS, Eisenberg MS, Aron M, et al. “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol. 2011;59:128.

    Article  PubMed  Google Scholar 

  84. White WM, Goel RK, Haber GP, et al. Robotic partial nephrectomy without renal hilar occlusion. BJU Int. 2010;105:1580.

    Article  PubMed  Google Scholar 

  85. Hyams ES, Perlmutter M, Stifelman MD. A prospective evaluation of the utility of laparoscopic Doppler technology during minimally invasive partial nephrectomy. Urology. 2011;77:617.

    Article  PubMed  Google Scholar 

  86. Tobis S, Knopf J, Silvers C, et al. Near infrared fluorescence imaging with robotic assisted laparoscopic partial nephrectomy: initial clinical experience for renal cortical tumors. J Urol. 2011;186:47.

    Article  PubMed  Google Scholar 

  87. White WM, Haber GP, Goel RK, et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology. 2009;74:801.

    Article  PubMed  Google Scholar 

  88. Stein RJ, White WM, Goel RK, et al. Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol. 2010;57:132.

    Article  PubMed  Google Scholar 

  89. Kaouk JH, White WM, Goel RK, et al. NOTES transvaginal nephrectomy: first human experience. Urology. 2009;74:5.

    Article  PubMed  Google Scholar 

  90. Haber GP, Crouzet S, Kamoi K, et al. Robotic NOTES (Natural Orifice Translumenal Endoscopic Surgery) in reconstructive urology: initial laboratory experience. Urology. 2008;71:996.

    Article  PubMed  Google Scholar 

Download references

Disclosures

J. M. Reyes: none; M. C. Smaldone: none. Dr. Robert Uzzo has received payment for serving on the Speaker’s Bureau for Pfizer. R. Viterbo: none.

Author information

Authors and Affiliations

  1. Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA

    Jose M. Reyes, Marc C. Smaldone, Robert G. Uzzo & Rosalia Viterbo

Authors
  1. Jose M. Reyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc C. Smaldone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert G. Uzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosalia Viterbo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosalia Viterbo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reyes, J.M., Smaldone, M.C., Uzzo, R.G. et al. Current Status of Robot-Assisted Partial Nephrectomy. Curr Urol Rep 13, 24–37 (2012). https://doi.org/10.1007/s11934-011-0223-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-011-0223-z

Keywords

Search

Navigation