Robotic Partial Nephrectomy for Solitary Kidney: A Multi-institutional Analysis - 27/12/12

Doi : 10.1016/j.urology.2012.08.055

Shahab P. Hillyer ^a, Sam B. Bhayani ^b, Mohamad E. Allaf ^c, Craig G. Rogers ^d, Michael D. Stifelman ^e, Youssef Tanagho ^b, Jeffrey K. Mullins ^c, Yichun Chiu ^e, Bartosz F. Kaczmarek ^d, Jihad H. Kaouk ^a,^⁎
^a Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
^b Division of Urologic Surgery, Washington University School of Medicine, Saint Louis, Missouri
^c James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
^d Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
^e Department of Urology, New York University, Langone Medical Center, New York, New York

Reprint requests: Jihad H. Kaouk, M.D., Zegarac-Pollock Professor of Surgery, Director, Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

Abstract

Objective

To evaluate the outcomes of robotic partial nephrectomy (RPN) for solitary kidney in a large multicenter series.

Materials and Methods

Medical records of 886 consecutive patients who underwent RPN at 5 academic institutions from May 2007 to May 2012 were retrospectively analyzed. Data were prospectively collected in an Investigational Review Board-approved protocol. Experienced robotic surgeons performed all operations. Patient demographics, functional, perioperative, and early oncologic outcomes were analyzed.

Results

A total of 26 patients with a solitary kidney were identified and included in the analysis; of these, 16 (62%) had solitary kidneys secondary to a previous malignancy. Perioperative outcomes included a median warm ischemia time of 17 minutes (interquartile range, 12, 28 minutes). Only 2 intraoperative complications occurred. One was a renal vein injury and one an aortic vessel tear, and both patients required intraoperative blood transfusions. No conversions to laparoscopy or open surgery occurred. There were 3 postoperative complications (11.5%). Median follow-up was 6 months (interquartile range, 5, 9.7 months). Postoperative renal function did not change significantly as measure by estimated glomerular filtration rate (−15.8%; P = .13). None of the patients required dialysis. Positive margins occurred in 1 patient, with 73% of patients having a renal cell carcinoma.

Conclusion

We report a multi-institutional series of RPN in patients with solitary kidney presenting with small renal masses. Our findings suggest that RPN represents a feasible treatment option in this specific population by offering reliable preservation of renal function, low surgical morbidity, and early oncologic safety in the hands of experienced robotic surgeons.

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Plan

Materials and Methods

Financial Disclosure: Sam Bhayani is a paid consultant to Baxter. Michael Stifelman is a paid consultant to Intuitive, Baxter, and VTI. Jihad Kaouk is a paid consultant to Intuitive, Endocare, Ethicon, and Covidien.