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Robotic Radical Nephrectomy for Massive Renal Tumors
Ronney Abaza1, Robert S Gerhard1, Oscar Martinez1
1Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio.
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|November 22, 2019
Summary
Robotic radical nephrectomy (RRN) is feasible for massive kidney tumors (≥15cm). This study shows RRN can be safely performed with excellent outcomes, even for locally advanced cancers, challenging prior controversies.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- The role of robotic surgery in radical nephrectomy remains debated, with concerns about cost-effectiveness and benefits over traditional laparoscopic methods.
- Robotic radical nephrectomy (RRN) is increasingly adopted, but its efficacy in managing extremely large renal masses is not well-established.
Purpose of the Study:
- To evaluate the feasibility and outcomes of RRN for massive renal tumors (≥15 cm).
- To determine if RRN is justifiable for complex, large renal masses where partial nephrectomy is not an option.
Main Methods:
- Prospective database review of patients undergoing RRN by a single experienced surgeon for renal masses ≥15 cm.
- Inclusion of all such cases without exclusion to minimize selection bias, including those with complex local invasion or thrombus.
Main Results:
- Fifteen patients with tumors averaging 19 cm underwent RRN, with some requiring concurrent procedures like liver resection or splenectomy.
- All RRNs were completed robotically without conversion, transfusions, or significant complications, with a mean operative time of 235 minutes.
- High success rate with 80% of patients discharged on postoperative day 1, a median length of stay of 1 day, and no 90-day readmissions.
Conclusions:
- Robotic radical nephrectomy is a safe and feasible option for massive renal tumors.
- Excellent outcomes and minimal complications suggest RRN is justifiable for complex, large renal malignancies.
