Researchers from Washington University, Henry Ford Hospital, and NYU Langone Medical Center have reported that robot-assisted partial nephrectomy (RAPN) is a safe and effective alternative to laparoscopic partial nephrectomy (LPN) for renal tumors. The details of this study appeared in the September 2009 issue of the Journal of Urology.[1]

Robot-assisted surgical techniques appear to be replacing conventional laparoscopic techniques for prostate and renal surgery. The purported advantages of robotic techniques are minimal blood loss and shorter recovery time. Robotic surgery is being increasingly evaluated for performing total and partial nephrectomies. When partial nephrectomy is performed, one of the main considerations is warm ischemia time. Because increased time of warm ischemia is associated with acute and possible long-term renal damage, attempts are made to keep this time under 30 minutes.

This study compared 118 laparoscopic partial nephrectomies with 129 RAPNs performed by three surgeons in three different institutions between 2004 and 2008. These three surgeons were very experienced in LPN and RAPN. Patient and tumor characteristics between the two groups were comparable.

• Operative time was 189 minutes for RAPN and 174 minutes LPN.
• Tumor size was 2.8 cm for RAPN and 2.5 cm for LPN.
• Positive margin rate was 3.9% for RAPN and 1% for LPN.
• Blood loss was 155 mL for RAPN and 196 mL for LPN.
• Average hospital stay was 2.4 days for RAPN and 2.7 days for LPN.
• Warm ischemia time was 19.7 minutes for RAPN and 28.4 minutes for LPN. 
• There were no intraoperative complications in the RAPN group, and 1 adrenal injury in the LPN group.
• Postoperative complications occurred in 8.6% of the RAPN group and 10.2% of the LPN group.

Comments: These authors suggest that the shorter warm ischemia time could facilitate preservation of remaining renal tissue compared with LPN.

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