Abstract
Introduction:
Nephron-sparing surgery (NSS) has become the norm for the management of small renal masses. Robot-assisted partial nephrectomy (RAPN) is a viable option for patients and surgeons who desire a minimally invasive alternative for the performance of NSS. In this video, we describe the indications, instrumentation, setup, technique, and novel developments for transperitoneal RAPN using a 2- or 3-arm approach.
Materials and Methods:
Indications for RAPN are the same as for laparoscopic partial nephrectomy (LPN) and include small renal masses in patients with pre-existing kidney disease. Transperitoneal RAPN is performed with the patient in the flank position, and port placement is done in either the medial or lateral camera position. The operative technique consists of the following steps: bowel mobilization, hilar dissection, tumor identification, hilar clamping, tumor excision, renal reconstruction, hilar unclamping, and specimen retrieval. Standard postoperative care is instituted and early ambulation is encouraged. The patient is usually discharged within 2 days. In this video, we demonstrate a number of recent technical advances such as use of a flexible Doppler probe for identification of hilar vessels under console surgeon control; TilePro and laparoscopic ultrasonography for tumor identification; robotically applied bulldog clamps to give the console surgeon control over hilar clamping and sliding clip renorrhaphy technique incorporating barbed suture for efficient renal reconstruction and lower warm ischemia times.
Results and Conclusions:
RAPN appears to have a shorter learning curve than alternative techniques of minimally invasive partial nephrectomy. Outcomes from multiple series have confirmed the safety and feasibility of RAPN, even for complex tumors. When compared to LPN, RAPN has demonstrated favorable-to-equivalent functional and oncological outcomes. In conclusion, RAPN extends the benefits of minimally invasive NSS to a wider section of surgeons and patients and may be an acceptable alternative to LPN for small renal masses.
No competing financial interests exist.
Runtime of video: 11 mins
Keywords
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