Robotic partial N ephrectomy- i nitial c linical e xperience

1. No. 183 Robotic partial Nephrectomy- initial clinical experience Gupta A, Malone GJM Greenslopes Hospital. Brisbane, Queensland, Australia Posters Proudly Supported by: Introduction Renal carcinoma is the 8th most common cancer in Australia and responsible for 2.4% of cancer deaths. 60% of tumors are <4cm in size.Data indicates no significant difference in cancer-specific survival between patients undergoing partial nephrectomy for tumors sized 7 cm or less or radical nephrectomy. Open partial nephrectomy has become the reference standard for treatment of small renal masses. Since 1993 Laparoscopic partial nephrectomy has become a viable option to open partial nephrectomy1. Technical challenges in tumor dissection and intra-corporeal suturing have been recognised impediment's to widespread acceptance. Robotic assisted laparoscopic surgery has overcome such challenges. Results 11 patients underwent Robot Assisted Laparoscopic Partial Nephrectomy over 31 months at one centre with one surgeon. There were 8 males and 3 females. With average age of 64 yrs. (47-76) and a BMI of 28(21-32). None of these patients had chronic kidney disease or were dialysis dependent. 4 of the patients were diabetic and 4 hypertensive. While one of the patients had a previous laparoscopic nephrectomy, another had a contralateral open partial nephrectomy . Only one patient had bilateral tumours.. 4 of the operated tumors were on the right side and 7 on the left. There were 3 mid pole, 2 inter-polar and 6 lower pole tumors. With an average size of 2.4 cm (1.3-4.5 cm). The collecting system was involved in one of the patients. One of the patients required coronary care admission for new onset AF and another one Intensive care unit monitoring for desaturation secondary to opiates. There was one patient who had a positive margin (Oncocytoma). There were 3 papillary, 4 clear cell, 2 chromophobe renal cell carcinomas; and 2 oncocytomas noted Operative details Aim We report our initial experience of 11 cases of robotic partial nephrectomy. Methods One Centre - Greenslopes Private Hospital Single Surgeon Time period of study: April 2010 to Nov 2012 (31 months) Patients with bilateral renal tumours, previous major abdominal surgery were included. Ultrasound Scan and CT scan were used to define lesions. Retrospective analysis for clinical characteristics and pathological findings was undertaken. Comparative analysis with contemporary studies Conclusions Initial results indicate robotic partial nephrectomy is a viable option in the local setting. However, there are higher costs incurred and there is limited availability of the technology. Long term follow up is in progress. Further review is required with greater case load to rule out heterogeneity in results. • References • Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors.JUrol 2008; 178:41-46 Gill IS et al • da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Kaul S et al European Urology 2007, 51(1):186-91 • Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Gettman et Al J Urol2004:64:914-8 • Robotic partial nephrectomy: a multi-institutional analysis. Rogers et al. J of robotic surg 2008:vol 2 141-3 Acknowledgements This was an independent retrospective analysis. The authors did not receive any financial assistance from any source for this study.