Background and Purpose: With the advent of robotics, it may be more feasible to offer minimally invasive nerve-sparing surgery (NSS), in the form of partial nephrectomy (PN), for patients with metachronous recurrence in the ipsilateral kidney after previous NSS.
We studied the outcomes of patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN) after previous ipsilateral open or laparoscopic NSS for renal-cell carcinoma.
Methods: In this Institutional Review Board approved study, a prospectively maintained PN database was reviewed. Of 230 RAPNs performed between 2003 and 2011, five patients underwent RAPN after previous ipsilateral NSS.
Results: The mean age was 64.2 years, and time between the first and second surgery was 27 months (range 9-60 mos). All patients were men and previously had open (n=4) or laparoscopic (n=1) NSS for clear-cell (n=2), papillary (n=2), and other (n=1) pathology. Average follow-up was 15.6 months (range 8-21 mos). There were no conversions to open surgery or radical nephrectomy. Total and selective arterial clamping were performed in two and two cases, respectively. One RAPN was performed off-clamp. Mean warm ischemia time was 14 minutes (range 0-32 min), and mean blood loss was 220 mL (range 50-400 mL). Average length of stay was 1.4 days (range 1-2 days) with no perioperative complications. The glomerular filtration rate decreased by a mean of 10%. There were no recurrences detected on cross-sectional imaging at the most recent follow-up.
Conclusion: RAPN after previous open or laparoscopic PN is safe and efficacious. It offers satisfactory intermediate functional and oncologic outcomes with minimal morbidity.
Written by:
Jain S, Yates JK, Munver R. Are you the author?
Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey.
Reference: J Endourol. 2012 Nov 12. Epub ahead of print.
doi: 10.1089/end.2012.0184
PubMed Abstract
PMID: 22967179
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