Robotic-assisted partial nephrectomy: Has it come of age?

Abstract

Surgical resection is the gold standard for the treatment of renal cell carcinoma, and partial nephrectomy (PN) is the treatment of choice for tumors smaller than 4 cm in size. A laparoscopic PN is a viable alternative to a traditional open PN, demonstrating good oncologic and functional outcomes. A laparoscopic PN is a challenging procedure, particularly performing intracorporeal suturing under the time constraints of warm ischemia. The introduction of the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA) with wristed instruments and magnified, 3-dimensional vision may facilitate the technical challenges of a minimally invasive PN. The technique of robotic partial nephrectomy (RPN) is still evolving and a number of institutions have recently reported their results. In this article, we present a review of the literature and our technique for robotic PN using a transperitoneal approach.

Figure 1

Use of TilePro during a robotic partial nephrectomy. TilePro image demonstrating the ability to simultaneously view live intraoperative ultrasound image (right lower corner) and preoperative CT image (left lower corner) on the console screen during a robotic partial nephrectomy. TilePro is being used to delineate tumor margins prior to tumor excision

Figure 2

Excision of the tumor during a robotic partial nephrectomy. Excision is preformed using cold Monopolar scissors in the right hand and a Maryland bipolar in the left hand. The left hand is turned 90° to provide upward traction while the assistant uses the suction to provide downward traction

Figure 3

Capsular closure using the sliding hemolock clip technique. A 0-vicryl suture is placed through the capsule on each side to compress the defect. A hemolock clip is placed on the near side, and the surgeon using the robotic instrument slides the clip down to cinch the defect closed