Utility of the third arm in robot-assisted laparoscopic partial nephrectomy for complex renal tumor / 中华泌尿外科杂志

ABSTRACT

Objective To assess the safety and feasibility of utility of the third arm in robotic partial nephrectomy(RPN) through retroperitoneal approach for complex renal tumor.Methods 36 roboticassisted partial nepbrectomy were performed by one surgeon between November 2015 and January 2017,including hilar tumors in 12 cases,central tumors in 11 cases,endophytic tumors in 7 cases and multiple tumors in 6 cases.A 12 mm camera port is placed 2 fingerbreadth above iliac crest.The lateral and medial robotic trocars are placed in the posterior axillary line and anterior axillary plane respectively parallel to the cameraport trocar.Under direct visualization,the peritoneum is swept medially towards the paramedianplane.The fourth arm trocar is placed in the most medial and inferior aspect of the field approximately 7 cm to 8 cm across and parallel to the medial robotic trocar.Descriptive statistics on patient characteristics,operative parameters,and oncologic outcomes are analyzed.Result The 4-arms retroperitoneal approach was used in all patients without any conversion.Mean console time was 127 ± 21 (98-357) min.Mean ischemia time was 25.5 ± 8.3 (12-38) min,Mean estimated blood lost was 198 ± 201.5 (50-510) ml.No patients required blood transfusion,except one case underwent selective intra-arterial embolization with DSA (digital subtraction angiography) and blood transfusion post-operatively.Pathology revealed renal cell carcinoma in 12 patients,angiomyolipoma in 16 patients,chromophobe renal cell carcinoma in 6 cases,oncocytoma in 2 cases and all had negative surgical margins.Under 3 months follow-up,Mean decrease in eGFR was 4.3 ml/(min · 1.73m2).No patients found recurrence or metastasis.Conclusions The third robotic arm provides the console surgeon maximal independence from the surgical assistant when performing kidney retraction,ligation or clamping of renal hilar vessels in complex renal morbidities.It would be beneficial for patient with merits of retroperitoneal approach and overcomes limited space during RPN.