Robotic-assisted partial nephrectomy

Abstract

PURPOSE OF REVIEW: Robotic-assisted partial nephrectomy (RAPN) continues to gain popularity in the setting of nephron-sparing surgery for small renal masses. Although the recent introduction of technological advancements has allowed for expanded roles for RAPN, the optimal techniques and approaches to the procedure remain controversial. RECENT FINDINGS: Of recent interest has been the role of warm ischemia time and its impact on postoperative renal function. Available studies suggest that although warm ischemia time remains an independent and modifiable risk factor for postoperative renal function, the role for 'zero ischemia' RAPN is still unclear. Recent studies on complex and/or larger tumors have demonstrated the feasibility of the procedure with comparable short-term outcomes to the open approach. Although these results should currently be considered experimental, they do shed light on the growing role for RAPN. Surgeon comfort and tumor location remain important factors when determining a retroperitoneal or transperitoneal approach. Available research demonstrates shorter operative times, length of stay and potentially lower costs to the retroperitoneal approach. SUMMARY: Robotic-assisted partial nephrectomy remains an evolving procedure. Although recent literature suggests the feasibility of new and novel techniques, variable approaches and expanded indications, prospective, long-term follow-up data are needed before a consensus can be reached.