Is robotic technology facilitating the minimally invasive approach to partial nephrectomy?

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Open partial nephrectomy has been defined as the standard of care for the treatment of small renal masses. Robotic platforms may offer the solution to bridge the gap between open and laparoscopic approaches, providing similar oncological and functional results via a shorter learning curve. This study reviews the current literature, and reports developments in robotic‐assisted partial nephrectomy (RPN). It highlights the important results from various studies which investigate the oncological and functional efficacy of RPN, and establishes its current status as at least equivalent to the laparoscopic approach. Trends are emerging that highlight the advantage of the robotic interface in facilitating this approach, and we postulate that this may become more apparent in future studies. OBJECTIVE•  To establish its current status, this study reviews the literature, and reports developments in robotic‐assisted partial nephrectomy (RPN), highlighting results from various studies that investigate the oncological and functional efficacy of RPN. Partial nephrectomy has become the standard therapy for the management of small renal masses. In an effort to overcome the perioperative morbidity associated with an open approach, and the extended warm ischaemia times associated with a laparoscopic approach, robotic platforms have been introduced.PATIENTS AND METHODS•  A search of Medline, EMBASE and Cochrane library databases was completed in July 2010 and used to identify pertinent original articles, editorials, comments and reviews, using the search term ‘partial nephrectomy’. Links to related references were surveyed, and all articles finally included were based on relevance and importance of content, as determined by the authors.RESULTS•  The robotic platform may offer the solution to bridge the gap between open and laparoscopic approaches, achieving warm ischaemia times that consistently average 20 minutes, and providing similar oncological and functional results via a shorter learning curve. It offers cosmesis and convalescence equivalent to that from laparoscopic partial nephrectomy, but with potentially fewer postoperative complications.CONCLUSION•  In terms of oncological and functional outcomes, the early experiences of RPN in selected series of patients appear at least equivalent to open and laparoscopic partial nephrectomy series. Randomized comparisons between the approaches are lacking, as are longer‐term follow‐up data for the robotic technique and formal cost analysis; these will be necessary before RPN can replace open partial nephrectomy as the new standard for the management of small renal masses. Trends continue to emerge that highlight the advantage of using the robotic platform to achieve a minimally invasive approach for partial nephrectomy, and with time and increasing expertise, this may become further apparent.