Robot-assisted partial nephrectomy: Is it the future of kidney surgery? A comparison of nephron-sparing techniques in partial nephrectomy
DOI:
https://doi.org/10.12775/QS.2024.20.53410Keywords
nephron-sparing surgery, robot-assisted partial nephrectomy, laparoscopic partial nephrectomy, open partial nephrectomy, zero-ischaemia partial nephrectomyAbstract
Technological advancements are significantly transforming various medical fields, including urology. The increasing adoption of minimally invasive surgical techniques and robotic assistance is particularly impactful. Three partial nephrectomy techniques are investigated: open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Among these, robot-assisted partial nephrectomy is considered to be superior due to shorter warm ischemia time, reduced blood loss, better early renal functional preservation, and shorter hospital stays. The zero-ischemia partial nephrectomy concept aims to improve postoperative kidney function outcomes. The integration of robotic technology and advancements in artificial intelligence and surgical training systems are expected to further enhance surgical techniques. Artificial intelligence, particularly when combined with computer vision algorithms, shows potential for creating precise and automated three-dimensional models for surgical planning in complex robot-assisted partial nephrectomy procedures, potentially leading to better patient outcomes. This review identifies the current capabilities and prospective advancements in the application of robotic technology in partial nephrectomy.
References
MERTZ L. (2022). Robots to Improve Surgery for All. IEEE pulse, 13(6), 6–11. https://doi.org/10.1109/MPULS.2022.3227808
Kim LHC, Patel MI. Increased utilization of partial nephrectomy in the robotic surgery era. ANZ J Surg. 2020 Jan;90(1-2):9-10. doi: 10.1111/ans.15644. PMID: 32067306.
Goran, Štimac., Ante, Reljić., Ivan, Pezelj., Igor, Grubišić., Danijel, Justinić., Šoipi, Šoip., Ivan, Svaguša., Davor, Trnski. (2014). The evolution of partial nephrectomy for kidney tumors--are we abandoning the basic principles of Robson's radical nephrectomy?. Acta Clinica Croatica, 53(4):455-461.
Ljungberg, B., Albiges, L., Abu-Ghanem, Y., Bedke, J., Capitanio, U., Dabestani, S., Fernández-Pello, S., Giles, R. H., Hofmann, F., Hora, M., Klatte, T., Kuusk, T., Lam, T. B., Marconi, L., Powles, T., Tahbaz, R., Volpe, A., & Bex, A. (2022). European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. European urology, 82(4), 399–410. https://doi.org/10.1016/j.eururo.2022.03.006
Motzer, R. J., Jonasch, E., Agarwal, N., Bhayani, S., Bro, W. P., Chang, S. S., Choueiri, T. K., Costello, B. A., Derweesh, I. H., Fishman, M., Gallagher, T. H., Gore, J. L., Hancock, S. L., Harrison, M. R., Kim, W., Kyriakopoulos, C., LaGrange, C., Lam, E. T., Lau, C., Michaelson, M. D., … Kumar, R. (2017). Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN, 15(6), 804–834. https://doi.org/10.6004/jnccn.2017.0100
Campbell, S., Uzzo, R. G., Allaf, M. E., Bass, E. B., Cadeddu, J. A., Chang, A., Clark, P. E., Davis, B. J., Derweesh, I. H., Giambarresi, L., Gervais, D. A., Hu, S. L., Lane, B. R., Leibovich, B. C., & Pierorazio, P. M. (2017). Renal Mass and Localized Renal Cancer: AUA Guideline. The Journal of urology, 198(3), 520–529. https://doi.org/10.1016/j.juro.2017.04.100
Mehra, K., Manikandan, R., Dorairajan, L. N., Sreerag, S., Jain, A., & Bokka, S. H. (2019). Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?. Journal of kidney cancer and VHL, 6(1), 8–12. https://doi.org/10.15586/jkcvhl.2019.115
Van Poppel, H., Da Pozzo, L., Albrecht, W., Matveev, V., Bono, A., Borkowski, A., Colombel, M., Klotz, L., Skinner, E., Keane, T., Marreaud, S., Collette, S., & Sylvester, R. (2011). A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European urology, 59(4), 543–552. https://doi.org/10.1016/j.eururo.2010.12.013
McKiernan, J., Simmons, R., Katz, J., & Russo, P. (2002). Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology, 59(6), 816–820. https://doi.org/10.1016/s0090-4295(02)01501-7
Huang, W. C., Elkin, E. B., Levey, A. S., Jang, T. L., & Russo, P. (2009). Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes?. The Journal of urology, 181(1), 55–62. https://doi.org/10.1016/j.juro.2008.09.017
Leppert, J. T., Lamberts, R. W., Thomas, I. C., Chung, B. I., Sonn, G. A., Skinner, E. C., Wagner, T. H., Chertow, G. M., & Brooks, J. D. (2018). Incident CKD after Radical or Partial Nephrectomy. Journal of the American Society of Nephrology : JASN, 29(1), 207–216. https://doi.org/10.1681/ASN.2017020136
Jordan, G. H., & Winslow, B. H. (1993). Laparoendoscopic upper pole partial nephrectomy with ureterectomy. The Journal of urology, 150(3), 940–943. https://doi.org/10.1016/s0022-5347(17)35656-2
Winfield, H. N., Donovan, J. F., Godet, A. S., & Clayman, R. V. (1993). Laparoscopic partial nephrectomy: initial case report for benign disease. Journal of endourology, 7(6), 521–526. https://doi.org/10.1089/end.1993.7.521
Alenezi, A., Novara, G., Mottrie, A., Al-Buheissi, S., & Karim, O. (2016). Zero ischaemia partial nephrectomy: a call for standardized nomenclature and functional outcomes. Nature reviews. Urology, 13(11), 674–683. https://doi.org/10.1038/nrurol.2016.185
Dias, B. H., Larcher, A., Dell'Oglio, P., Montorsi, F., El Khoury, F., D'Hondt, F., Schatteman, P., De Naeyer, G., & Mottrie, A. (2019). What's new in robotic partial nephrectomy. Novedades en nefrectomía parcial robótica. Archivos espanoles de urologia, 72(3), 283–292.
Ficarra, V., Rossanese, M., Gnech, M., Novara, G., & Mottrie, A. (2014). Outcomes and limitations of laparoscopic and robotic partial nephrectomy. Current opinion in urology, 24(5), 441–447. https://doi.org/10.1097/MOU.0000000000000095
Carbonara, U., Crocerossa, F., Campi, R., Veccia, A., Cacciamani, G. E., Amparore, D., Checcucci, E., Loizzo, D., Pecoraro, A., Marchioni, M., Lonati, C., Sundaram, C. P., Mehrazin, R., Porter, J., Kaouk, J. H., Porpiglia, F., Ditonno, P., Autorino, R., & YAU-EAU Kidney Cancer Working Group (2022). Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes. European urology open science, 40, 27–37. https://doi.org/10.1016/j.euros.2022.03.015
Zahid, A., Ayyan, M., Farooq, M., Cheema, H. A., Shahid, A., Naeem, F., Ilyas, M. A., & Sohail, S. (2023). Robotic surgery in comparison to the open and laparoscopic approaches in the field of urology: a systematic review. Journal of robotic surgery, 17(1), 11–29. https://doi.org/10.1007/s11701-022-01416-7
Vartolomei, M. D., Remzi, M., Fajkovic, H., & Shariat, S. F. (2022). Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review. Journal of clinical medicine, 11(20), 6165. https://doi.org/10.3390/jcm11206165
Porter, J., & Blau, E. (2020). Robotic-assisted partial nephrectomy: evolving techniques and expanding considerations. Current opinion in urology, 30(1), 79–82. https://doi.org/10.1097/MOU.0000000000000689
Veeratterapillay, R., Addla, S. K., Jelley, C., Bailie, J., Rix, D., Bromage, S., Oakley, N., Weston, R., & Soomro, N. A. (2017). Early surgical outcomes and oncological results of robot-assisted partial nephrectomy: a multicentre study. BJU international, 120(4), 550–555. https://doi.org/10.1111/bju.13743
Benway, B. M., Bhayani, S. B., Rogers, C. G., Porter, J. R., Buffi, N. M., Figenshau, R. S., & Mottrie, A. (2010). Robot-assisted partial nephrectomy: an international experience. European urology, 57(5), 815–820. https://doi.org/10.1016/j.eururo.2010.01.011
Aboumarzouk, O. M., Stein, R. J., Eyraud, R., Haber, G. P., Chlosta, P. L., Somani, B. K., & Kaouk, J. H. (2012). Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. European urology, 62(6), 1023–1033. https://doi.org/10.1016/j.eururo.2012.06.038
Cacciamani, G. E., Medina, L. G., Gill, T., Abreu, A., Sotelo, R., Artibani, W., & Gill, I. S. (2018). Impact of Surgical Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis. The Journal of urology, 200(2), 258–274. https://doi.org/10.1016/j.juro.2017.12.086
Wu, Z., Li, M., Song, S., Ye, H., Yang, Q., Liu, B., Cai, C., Yang, B., Xiao, L., Chen, Q., Lü, C., Gao, X., Xu, C., Gao, X., Hou, J., Wang, L., & Sun, Y. (2015). Propensity-score matched analysis comparing robot-assisted with laparoscopic partial nephrectomy. BJU international, 115(3), 437–445. https://doi.org/10.1111/bju.12774
Jiang, Y. L., Yu, D. D., Xu, Y., Zhang, M. H., Peng, F. S., & Li, P. (2023). Comparison of perioperative outcomes of robotic vs. laparoscopic partial nephrectomy for renal tumors with a RENAL nephrometry score ≥7: A meta-analysis. Frontiers in surgery, 10, 1138974. https://doi.org/10.3389/fsurg.2023.1138974
Chang, K. D., Abdel Raheem, A., Kim, K. H., Oh, C. K., Park, S. Y., Kim, Y. S., Ham, W. S., Han, W. K., Choi, Y. D., Chung, B. H., & Rha, K. H. (2018). Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up. BJU international, 122(4), 618–626. https://doi.org/10.1111/bju.14250
Choi, J. E., You, J. H., Kim, D. K., Rha, K. H., & Lee, S. H. (2015). Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. European urology, 67(5), 891–901. https://doi.org/10.1016/j.eururo.2014.12.028
Alenezi, A., Novara, G., Mottrie, A., Al-Buheissi, S., & Karim, O. (2016). Zero ischaemia partial nephrectomy: a call for standardized nomenclature and functional outcomes. Nature reviews. Urology, 13(11), 674–683. https://doi.org/10.1038/nrurol.2016.185
Volpe, A., Blute, M. L., Ficarra, V., Gill, I. S., Kutikov, A., Porpiglia, F., Rogers, C., Touijer, K. A., Van Poppel, H., & Thompson, R. H. (2015). Renal Ischemia and Function After Partial Nephrectomy: A Collaborative Review of the Literature. European urology, 68(1), 61–74. https://doi.org/10.1016/j.eururo.2015.01.025
Zargar, H., Akca, O., Ramirez, D., Brandao, L. F., Laydner, H., Krishnan, J., Stein, R. J., & Kaouk, J. H. (2015). The impact of extended warm ischemia time on late renal function after robotic partial nephrectomy. Journal of endourology, 29(4), 444–448. https://doi.org/10.1089/end.2014.0557
Nakamura, M., Ambe, Y., Teshima, T., Shirakawa, N., Inatsu, H., Amakawa, R., Inoue, Y., Yoshimatsu, T., Imai, S., Kusakabe, M., Morikawa, T., Kameyama, S., & Shiga, Y. (2021). Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for ≥T1b renal tumours. International journal of clinical oncology, 26(10), 1955–1960. https://doi.org/10.1007/s10147-021-01966-0
Zanoni, M., Grizzi, F., Vota, P., Toia, G., Mazzieri, C., Clementi, M. C., Beatrici, E., & Taverna, G. (2023). Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single centre. Central European journal of urology, 76(2), 123–127. https://doi.org/10.5173/ceju.2023.261
Gill, I. S., Eisenberg, M. S., Aron, M., Berger, A., Ukimura, O., Patil, M. B., Campese, V., Thangathurai, D., & Desai, M. M. (2011). "Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique. European urology, 59(1), 128–134. https://doi.org/10.1016/j.eururo.2010.10.002
Ng, C. K., Gill, I. S., Patil, M. B., Hung, A. J., Berger, A. K., de Castro Abreu, A. L., Nakamoto, M., Eisenberg, M. S., Ukimura, O., Thangathurai, D., Aron, M., & Desai, M. M. (2012). Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. European urology, 61(1), 67–74. https://doi.org/10.1016/j.eururo.2011.08.040
Wiener, S., Kiziloz, H., Dorin, R. P., Finnegan, K., Shichman, S. S., & Meraney, A. (2014). Predictors of postoperative decline in estimated glomerular filtration rate in patients undergoing robotic partial nephrectomy. Journal of endourology, 28(7), 807–813. https://doi.org/10.1089/end.2013.0640
Gill, I. S., Eisenberg, M. S., Aron, M., Berger, A., Ukimura, O., Patil, M. B., Campese, V., Thangathurai, D., & Desai, M. M. (2011). "Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique. European urology, 59(1), 128–134. https://doi.org/10.1016/j.eururo.2010.10.002
Foerster, B., Kimura, S., Vartolomei, M. D., Abufaraj, M., Gust, K., Fajkovic, H., Shariat, S. F., & Seitz, C. (2018). Robot-assisted partial nephrectomy: systematic review of functional results. Current opinion in urology, 28(2), 123–131. https://doi.org/10.1097/MOU.0000000000000482
Kaczmarek, B. F., Tanagho, Y. S., Hillyer, S. P., Mullins, J. K., Diaz, M., Trinh, Q. D., Bhayani, S. B., Allaf, M. E., Stifelman, M. D., Kaouk, J. H., & Rogers, C. G. (2013). Off-clamp robot-assisted partial nephrectomy preserves renal function: a multi-institutional propensity score analysis. European urology, 64(6), 988–993. https://doi.org/10.1016/j.eururo.2012.10.009
Satkunasivam, R., Tsai, S., Syan, S., Bernhard, J. C., de Castro Abreu, A. L., Chopra, S., Berger, A. K., Lee, D., Hung, A. J., Cai, J., Desai, M. M., & Gill, I. S. (2015). Robotic unclamped "minimal-margin" partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. European urology, 68(4), 705–712. https://doi.org/10.1016/j.eururo.2015.04.044
Ng, C. K., Gill, I. S., Patil, M. B., Hung, A. J., Berger, A. K., de Castro Abreu, A. L., Nakamoto, M., Eisenberg, M. S., Ukimura, O., Thangathurai, D., Aron, M., & Desai, M. M. (2012). Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. European urology, 61(1), 67–74. https://doi.org/10.1016/j.eururo.2011.08.040
Papalia, R., Simone, G., Ferriero, M., Guaglianone, S., Costantini, M., Giannarelli, D., Maini, C. L., Forastiere, E., & Gallucci, M. (2012). Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes. World journal of urology, 30(5), 671–676. https://doi.org/10.1007/s00345-012-0961-7
Antonelli, A., Cindolo, L., Sandri, M., Bertolo, R., Annino, F., Carini, M., Celia, A., D'Orta, C., De Concilio, B., Furlan, M., Giommoni, V., Ingrosso, M., Mari, A., Muto, G., Nucciotti, R., Porreca, A., Primiceri, G., Schips, L., Sessa, F., Simeone, C., … AGILE Group (Italian Group for Advanced Laparo-Endoscopic Surgery) (2020). Safety of on- vs off-clamp robotic partial nephrectomy: per-protocol analysis from the data of the CLOCK randomized trial. World journal of urology, 38(5), 1101–1108. https://doi.org/10.1007/s00345-019-02879-4
Serag, H., Agag, A., Naushad, N., Mukherjee, A., Harrington-Vogt, M., & Deb, A. A. (2023). Perioperative, Functional, and Oncologic Outcomes of On-Clamp Versus Off-Clamp Partial Nephrectomy: An Updated Meta-analysis of 9027 Patients. Urology research & practice, 49(2), 79–95. https://doi.org/10.5152/tud.2023.22207
Xia, L., Wang, X., Xu, T., & Guzzo, T. J. (2017). Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy. Journal of endourology, 31(9), 893–909. https://doi.org/10.1089/end.2016.0351
Rosiello, G., Palumbo, C., Deuker, M., Stolzenbach, L. F., Martin, T., Tian, Z., Larcher, A., Capitanio, U., Montorsi, F., Shariat, S. F., Kapoor, A., Saad, F., Briganti, A., & Karakiewicz, P. I. (2021). Partial nephrectomy in frail patients: Benefits of robot-assisted surgery. Surgical oncology, 38, 101588. https://doi.org/10.1016/j.suronc.2021.101588
Michele, Di, Dio., Simona, Barbuto., Claudio, Bisegna., Andrea, Bellin., Daniele, Amparore., P., Verri., G., Busacca., M., Sica., Sabrina, De, Cillis., Federico, Piramide., Alberto, Piana., Stefano, Alba., Gabriele, Volpi., Cristian, Fiori., Francesco, Porpiglia., Enrico, Checcucci. (2023). Artificial Intelligence-Based Hyper Accuracy Three-Dimensional (HA3D®) Models in Surgical Planning of Challenging Robotic Nephron-Sparing Surgery: A Case Report and Snapshot of the State-of-the-Art with Possible Future Implications. Diagnostics, doi: 10.3390/diagnostics13142320
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bartłomiej Ast, Igor Piotrowski, Krzysztof Dobrzeniecki
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 110
Number of citations: 0