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Role of Robotic Partial Nephrectomy in treatment of Renal Cell Carcinoma

Role of Robotic Partial Nephrectomy in treatment of Renal Cell Carcinoma

Renal Cell Carcinoma (RCC) is the commonest malignant neoplasm of the kidney and almost 200,000 new cases are detected annually and half of this number succumbs to this disease. The advent of ultrasound screening for unrelated abdominal symptoms has shifted the stage of diagnosis from a delayed stage to early, asymptomatic, localized disease, in which the treatment can be safely directed towards Nephron Sparing Surgery (NSS). This approach has been shown to be superior to radical nephrectomy in terms of long term development of renal impairment, cardiovascular morbidity and premature death in addition to psychological rehabilitation of patient with the thought that part of the kidney could be saved.

Laparoscopic NSS offered distinct advantage of reduced peri operative pain, hospital stay and estimated blood loss.The main problems with LPN were the steep learning curve even for the urologists familiar with laparoscopic skills, and a need to curtail warm ischemia time to 20 minutes.

Robotic technology has given a thrust towards nephron sparing surgery by offering the advantages of minimally invasive procedure with a shorter and less steep learning curve compared to laparoscopic operation and the oncologic benefit of open partial nephrectomy. The learning curve for Robotic Partial Nephrectomy (RPN) is shorter than laparoscopic procedure.  The three dimensional high definition camera, wristed small calibre instruments, wide range of movements and scaling of surgeons movements offer definite advantages over conventional laparoscopy. The technique of renorrhaphy done robotically offers to reduce warm ischemia time when compared to laparoscopic procedure. Studies have shown that the incidence of conversion to radical nephrectomy or open surgery is much more with laparoscopic procedure when compared with robotic . Renal cell carcinoma is resistant to both radiotherapy and chemotherapy. Therefore one should strive to achieve a complete oncological clearance while performing partial nephrectomy.Robotics adds to the advantage of dynamic imaging like intracorporeal ultrasound imaging. Robotic technology has revolutionized the treatment of renal cell carcinoma and this has primarily resulted in shift from radical nephrectomy to partial nephrectomy.

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