Drain Placement Can be Safely Omitted After the Majority of Robotic Partial Nephrectomies

Abstract

PURPOSE: Drain placement after partial nephrectomy is considered standard but it is based on routine and not on evidence. With experience we performed robotic partial nephrectomy and routinely omitted a drain even with significant collecting system violation. We have rarely used drains after robotic partial nephrectomy for several years, and we report our outcomes. MATERIALS AND METHODS: We reviewed a single surgeon, prospective database of all robotic partial nephrectomies from February 2008 to March 2012, including the characteristics of those with and without a drain. RESULTS: The 150 patients underwent a total of 160 robotic partial nephrectomy procedures with a drain used in 11 patients and omitted in 93%. Mean patient age was 57 years (range 22 to 89), mean American Society of Anesthesiologists score was 2.8 (range 2 to 4) and mean body mass index was 32 kg/m(2) (range 18 to 54). Values were similar in patients with and without a drain. In patients without a drain and in those with a drain mean tumor size was 3.5 cm (range 1.0 to 11.0) and 4.6 cm (range 1.1 to 8.6), and mean R.E.N.A.L. (radius, exophytic/endophytic, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar tumor touching main renal artery or vein) nephrometry score was 7.8 (range 4 to 12) and 8.8 (range 6 to 11), respectively. Collecting system violation occurred in 88 patients (59%), including 78 without a drain. Two patients (1.3%) required transfusion with no intervention for bleeding. All except 5 patients (97%) were discharged home on postoperative day 1 with all drains removed before discharge. In 2 patients (1.3%) without a drain small urinomas without infection developed more than 2 weeks postoperatively, which were treated with a week of Foley catheter drainage and percutaneous drainage, respectively. CONCLUSIONS: Drain placement after robotic partial nephrectomy can be routinely omitted with a low rate of urine leaks, which can be managed safely when they rarely occur.