Objectives: To report the surgical outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) in our hospital.
Materials and Methods: We retrospectively reviewed the surgical outcomes in the patients who underwent RAPN between July 2014 and March 2018 (n=58). In all cases, we preoperatively performed the ureteral stent placement. We resected tumors under warm ischemia. An inner running suture was placed using 3-0 V-Loc and the renorrhaphy was placed using 2-0 V-Loc.
Results: The median age was 63 years (range: 15-84 years) and 42 patients (72.4%) were male. The median tumor diameter was 25mm (range: 13-55mm), and clinical stage was T1a in 51 patients and T1b in 7 patients. The median R.E.N.A.L nephrometry score was 6.0 (range: 4-10). We utilized the transperitoneal approach and retroperitoneal approach in 44 cases and 14 cases, respectively. The renal arteries were clamped in 56 cases (96.6%), and early unclamping was performed in 16 cases (27.6%). The median operation time, console time and ischemic time were 220 min (range:131-353 min), 154 min (range: 92-277 min) and 21 min (range: 0-41 min), respectively. The median estimated blood loss was 58mL (5-950mL). The operation method was converted to open partial nephrectomy in 2 cases (6.1%) because of the injury of tumor capsule. The pathological diagnosis was clear cell renal cell carcinoma in 52 cases and benign tumor in 6 cases, and the surgical margin was positive in two cases (3.4%). The eGFR reduction rate was 13.7% (range: -10.7-43.3%) at one week, 9.5% (range: -22.6-42.2%) at one month and 9.5% (range: -18.7-57.8%) at three months after surgery. The postoperative complication rate ≧ Clavien-Dindo 3a was 6.9% (Symptomatic pseudoaneurysm in two cases, urinary leakage in one case and postoperative bleeding in one case).
Conclusions: The surgical outcomes of RAPN in our hospital were comparable to those reported previously, however the postoperative complication rate was relatively high.