Zero-ischemia robotic assisted partial nephrectomy – Preliminary experience in a single institution

Purpose: Partial nephrectomy is the reference standard treatment modality for small renal masses. Robotic assisted laparoscopic partial nephrectomy (RPN) is increasingly used. Warm ischemia is thought to be necessary in controlling bleeding and facilitating tumor resection. However prolonged warm ischemia may damage renal function. Herein, we report our preliminary experience on the zero-ischimia RPN.

Materials and Methods: From June 2014 to February 2016, 5 patients underwent zero-ischemia RPN in our institution. Among them 3 were female and 2 were male. The median age was 60 (22–71) years old. The robotic docking and port placement were the same as the conventional warm ischemic RPN. The renal arteries were dissection and zero ischemia was achieved by highly selective control or no control.

Results: The median operation time was 185 (125–250) minutes and median blood loss is 100 (100–450) ml. Three patients did not have any control of the renal arteries at all and 2 patients had a high-selective control of the renal arteries.No intra-operative complication was noted and no blood transfusion was required. The pathological results of the patients were 3 angiomyolipoma, 1 renal cell carcinoma and 1 hemorrhagic renal cyst. The median tumor size was 5.7 (1.6–13) cm. The median R.E.N.A.L score was 7 (4–10).The median hospital stay was 6 (4–7) days and post-operative complication was noted in 1 patient with wound dehiscence. Pre- and post-operative creatinine levelswere 0.86 (0.58–1.09) and 0.88 (0.62–0.9), respectively.

Conclusion: Zero-ischemia RPN is safe and feasible in selected patients even with large tumor size. The renal function could be preserved. Long-term benefits require further investigation.