Robot-assisted partial nephrectomy

Superiority over laparoscopic partial nephrectomy

Ryoichi Shiroki, Naohiko Fukami, Kosuke Fukaya, Mamoru Kusaka, Takahiro Natsume, Takashi Ichihara, Hiroshi Toyama

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robot-assisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm2, we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy will be more frequently carried out as a safe, effective and minimally-invasive nephron-sparing surgery procedure.

Original languageEnglish
Pages (from-to)122-131
Number of pages10
JournalInternational Journal of Urology
Volume23
Issue number2
DOIs
Publication statusPublished - 01-02-2016

Fingerprint

Nephrectomy
Warm Ischemia
Nephrons
Kidney
Robotics
Neoplasms
Cold Ischemia
Postoperative Hemorrhage
Minimally Invasive Surgical Procedures
Surgical Instruments
Japan
Quality of Life
Urine
Prospective Studies
Technology

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Shiroki, Ryoichi ; Fukami, Naohiko ; Fukaya, Kosuke ; Kusaka, Mamoru ; Natsume, Takahiro ; Ichihara, Takashi ; Toyama, Hiroshi. / Robot-assisted partial nephrectomy : Superiority over laparoscopic partial nephrectomy. In: International Journal of Urology. 2016 ; Vol. 23, No. 2. pp. 122-131.
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Shiroki, R, Fukami, N, Fukaya, K, Kusaka, M, Natsume, T, Ichihara, T & Toyama, H 2016, 'Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy', International Journal of Urology, vol. 23, no. 2, pp. 122-131. https://doi.org/10.1111/iju.13001

Robot-assisted partial nephrectomy : Superiority over laparoscopic partial nephrectomy. / Shiroki, Ryoichi; Fukami, Naohiko; Fukaya, Kosuke; Kusaka, Mamoru; Natsume, Takahiro; Ichihara, Takashi; Toyama, Hiroshi.

In: International Journal of Urology, Vol. 23, No. 2, 01.02.2016, p. 122-131.

Research output: Contribution to journalReview article

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AU - Shiroki, Ryoichi

AU - Fukami, Naohiko

AU - Fukaya, Kosuke

AU - Kusaka, Mamoru

AU - Natsume, Takahiro

AU - Ichihara, Takashi

AU - Toyama, Hiroshi

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Shiroki R, Fukami N, Fukaya K, Kusaka M, Natsume T, Ichihara T et al. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy. International Journal of Urology. 2016 Feb 1;23(2):122-131. https://doi.org/10.1111/iju.13001