Is robotic partial nephrectomy convenient for solitary kidney?

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Nephron sparing surgery (NSS) is crucial for preserving renal function in patients with a solitary kidney.
• Open partial nephrectomy (OPN) has been the traditional standard for NSS.
• Robotic partial nephrectomy (RPN) is increasingly adopted for solitary kidneys and complex renal tumors.

Purpose of the Study:

• To compare the safety and efficacy of Robotic Partial Nephrectomy (RPN) versus Open Partial Nephrectomy (OPN) in patients with solitary kidneys.
• To evaluate intraoperative-postoperative complications and positive surgical margin rates for both surgical approaches.
• To assess the feasibility of RPN for complex renal masses in solitary kidneys.

Main Methods:

• Retrospective analysis of patients with solitary kidneys undergoing partial nephrectomy for small renal masses.
• Comparison of outcomes between RPN and OPN groups, focusing on complication rates and positive surgical margins.
• Monitoring of warm ischemia time (WIT) for all procedures.

Main Results:

• No significant difference in intraoperative-postoperative complication rates between RPN (7.5%) and OPN (8%).
• Similar positive surgical margin (PSM) rates for RPN and OPN.
• Warm ischemia time (WIT) remained within the acceptable range (<25 minutes) for robotic approaches.

Conclusions:

• Robotic partial nephrectomy (RPN) is a safe and effective approach for managing solitary kidney tumors, with outcomes comparable to OPN.
• Increasing surgical experience enhances the safety of RPN for solitary kidneys.
• Intracorporeal ice slush may be a valuable adjunct for complex tumors potentially exceeding 25 minutes of WIT.