Results and initial experience of robot – assisted radical nephrectomy at Binh Dan Hospital

Abstract

Introduction: To evaluate and analyze the initial experience of robot-assisted radical nephrectomy (RARN) at Binh Dan Hospital.

Patients and Methods: We retrospectively analyzed data from 46 patients diagnosed with renal tumors who underwent RARN at Binh Dan Hospital from January 2023 to May 2024. Clinical characteristics, surgical procedures, and complications were recorded and analyzed.

Results: 46 patients (29 males, 17 females, median age 58 years, range 48 to 69) were treated. The median tumor diameter was 68 mm with 24, 20 and 2 patients were classified into cT₁N₀M₀, cT₂N₀M₀ and cT_3aN₀M₀, respectively. No patients required conversion to open surgery, and the median operative time and docking time were 158 and 14 minutes, respectively. The median estimated blood loss was 46ml, and no patient required blood transfusion. During the perioperative period, no major complications corresponding to Clavien-Dindo grade ≥ 3 occurred.

Conclusion: Based on this study, we preliminarily conclude that RARN is a safe and effective method. The study also helps reinforce the evidence that RARN as a promising alternative solution to conventional laparoscopic surgery in cases of complex renal tumors or instances where robot-assisted partial nephrectomy is not feasible.

Keywords: Robot-assisted radical nephrectomy, renal tumor, renal

cell carcinoma.

References

1. Van Poppel H, Becker F, Cadeddu JA, et al. Treatment of localised renal cell carcinoma. Eur Urol. 2011;60:662-672.
2. Dunn MD, Portis AJ, Shalhav AL, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol. 2000;164:1153-1159.
3. Chen Y, Zhang S, Wu Z, et al. Review of surgical robotic systems for keyhole and endoscopic procedures: state of the art and perspectives. Front Med. 2020;14:382-403.
4. Dagenais J, Bertolo R, Garisto J, et al. Variability in partial nephrectomy outcomes: does your surgeon matter? Eur Urol. 2019;75:628-634.
5. Shin TJ, Song C, Kim CS, et al. Surgical details and renal function change after robot-assisted partial nephrectomy. Int J Urol. 2020;27:457-462.
6. Motoyama D, Sato R, Watanabe K, et al. Perioperative outcomes in patients undergoing robot-assisted partial nephrectomy: comparative assessments between complex and noncomplex renal tumors. Asian J Endosc Surg. 2021;14:379-385.
7. Klingler DW, Hemstreet GP, Balaji KC. Feasibility of robotic radical nephrectomy—initial results of single-institution pilot study. Urology. 2005;65:1086-1089.
8. Jeong IG, Khandwala YS, Kim JH, et al. Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015. JAMA. 2017;318:1561-1568.
9. Gershman B, Bukavina L, Chen Z, et al. The association of robot-assisted versus pure laparoscopic radical nephrectomy with perioperative outcomes and hospital costs. Eur Urol Focus. 2020;6:305-312.
10. Anele UA, Marchioni M et al. Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group). World J Urol. 2019;37:2439-2450.
11. Asimakopoulos AD, Miano R, Annino F, et al. Robotic radical nephrectomy for renal cell carcinoma: a systematic review. BMC Urol. 2014;14:75.
12. Golombos DM, Chughtai B et al. Adoption of technology and its impact on nephrectomy outcomes, a U.S. population-based analysis (2008-2012). J Endourol. 2017;31:91-99.
13. Kates M, Ball MW, Patel HD, et al. The financial impact of robotic technology for partial and radical nephrectomy. J Endourol. 2015;29:317-322.
14. Xia L, Talwar R, Taylor BL, et al. National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol. 2019;37:182.e17-182.e27.
15. Li J, Peng L et al. Comparison of perioperative outcomes of robot-assisted vs laparoscopic radical nephrectomy: a systematic review and meta-analysis. Front Oncol. 2020;10: 551052.
16. Motoyama D, Matsushita Y, Watanabe H, et al. Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy. BMC Urol. 2019;19:132.
17. Motoyama D, Matsushita Y, Watanabe H, et al. Improved perioperative outcomes by early unclamping prior to renorrhaphy compared with conventional clamping during robot-assisted partial nephrectomy: a propensity score matching analysis. J Robot Surg. 2020;14:47-53.