ENDOUROLOGY & LAPAROSCOPY

Robot Assisted Laparoscopic Partial Nephrectomy: Initial Experience
Caruso RP, Phillips CK, Kau E, Taneja SS, Stifelman MD
Department of Urology, New York University School of Medicine, New York, New York
J Urol. 2006; 176: 36-39

• Purpose: Advances in laparoscopy have made laparoscopic partial nephrectomy a technically feasible procedure but it remains challenging to even experienced laparoscopists. We hypothesized that robotic assisted laparoscopic partial nephrectomy may make this procedure more efficacious than the standard laparoscopic approach.
• Materials and Methods: Ten patients with a mean age of 58 years and mean tumor size of 2.0 cm underwent robotic assisted laparoscopic partial nephrectomy and another 10 with a mean age of 61 years and mean tumor size of 2.18 cm underwent laparoscopic partial nephrectomy, as performed by a team of 2 surgeons (MS and ST) between May 2002 and January 2004. Demographic data, intraoperative parameters and postoperative data were compared between the 2 groups.
• Results: There were no significant differences in patient demographics between the 2 groups. Intraoperative data and postoperative outcomes were statistically similar. In the 10 patients who underwent robotic assisted laparoscopic partial nephrectomy there were 2 intraoperative complications. There was 1 conversion in the laparoscopic partial nephrectomy group.
• Conclusions: Robotic assisted laparoscopic partial nephrectomy is a safe and feasible procedure in patients with small exophytic masses. The robotic approach to laparoscopic partial nephrectomy does not offer any clinical advantage over conventional laparoscopic nephrectomy.
  
  
• Editorial Comment
  Advances in laparoscopy allowed surgeons to perform complex reconstructive and ablative surgical procedures. Laparoscopic partial nephrectomy is the best example to depict these innovations where accuracy, speed and surgeon’s expertise must work in concert. Robotic surgery may bring some advantages to the novice laparoscopists when performing laparoscopic radical prostatectomies but for nephron-sparing nephrectomies does not appear to help. Although the authors acknowledge the need of randomization of larger number of patients for clinical validation, this study is a pioneer comparing laparoscopic partial nephrectomy (LPN) versus robotic assisted laparoscopic partial nephrectomy (RALPN). Interestingly, the authors believe that the distance between the surgeon and the sterile surgical field may have decreased the threshold to convert the RALPN to a hand assisted or open procedure. Other potential disadvantages of the robotic system are cost, training, equipment malfunction and setup time. Additionally, while LPN can safely be performed with a primary surgeon and an assistant, RALPN is a procedure that must be done with 2 experienced surgeons. In conclusion, RALPN is not ready for primetime yet.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA