Robotic partial nephrectomy with segmental ischemia


Associate Professor of Urology

Departments of Endourology & Robotic Surgery
Group Florence Nightingale Hospitals
Istanbul Turkey

Although active surveillance and ablative technologies like cryotherapy and radiofrequency have emerged over last decade, partial nephrectomy is the treatment of choice for organ confined small renal masses. Open partial nephrectomy (PN) continues to be the reference nephron-sparing surgery procedure. Over the last two decades laparoscopic techniques developed to reproduce the open PN in minimally invasive fashion. However due to technical difficulties laparoscopic PN has been mainly limited to experienced laparoscopic surgeons.
Robotic technology is being increasingly used in urologic surgery. The current robotic system has facilitated performing complex procedures like radical prostatectomy and PN.
Recently some new techniques have been developed to avoid total renal ischemia during laparoscopic and robotic PN. Selective occlusion of renal arterial branches supplying only the tumor and close vicinity is possible through micro dissection and using small bulldog clamps,. The main renal artery and vein stays open during the entire procedure, reducing ischemic damage. Also early unclamping just before parenchymal renorraphy, after completion of tumor resection and base sutures shortens the warm ischemia time. Because of 3D vision and 6 degrees of intuitive movements, which are unique to robotic technology, may allow faster resections and reconstruction, thereby reducing warm ischemia time.
Gettman at al were the first, reporting the feasibility of robotic PN in 2004. Now increasing number of series from many centers has been reported. At our center robotic PN program was started in 2008. In this presentation our current technique of segmental ischemic robotic PN with the accompanying video clips is described.