Outcomes of Robotic Nephrectomy Including Highest-complexity Cases: Largest Series to Date and Literature Review

ObjectiveTo review the outcomes of robot-assisted laparoscopic nephrectomy (RALN) after 101 consecutive cases, the largest reported series to date. The benefit of adding robotic technology to laparoscopic nephrectomy is unclear and controversial. We used robotics for nephrectomy routinely, including for simpler cases rather than laparoscopy, as well as for the most complex nephrectomies rather than open surgery.MethodsWe reviewed a prospective database of 101 consecutive nephrectomy procedures by a single surgeon (R.A.). All were initiated as RALN regardless of complexity. Patient characteristics and outcomes were reviewed, including tumor complexity, conversion rate, transfusions, length of stay, and complications.ResultsMean age was 60 years (19-86 years), and mean body mass index was 31 kg/m2 (16-54 kg/m2). Ninety patients had tumors with mean size of 8.2 cm (2.2-25.8 cm). Eighty were malignant, including 31 pT3a tumors (39%), with 9 renal vein thrombi. Eight malignancies had caval tumor thrombi (10%). Local invasion required 1 bowel resection, 1 partial hepatectomy, and 1 distal pancreatectomy, all performed robotically with no conversions to open surgery. Ipsilateral retroperitoneal lymphadenectomy was performed in 40 patients removing 13.7 nodes (4-36). Mean operative time and blood loss were 172 minutes (57-411 minutes) and 67 mL (10-400 mL) with only 1 transfusion (1%). Mean length of stay was 1.1 days (0-7 days), with 94% discharged by postoperative day 1. Clavien grade III-IV complications occurred in 5% without deaths.ConclusionRobotic nephrectomy allows for consistent outcomes regardless of procedure complexity. Completion of procedures without need for open conversion was possible even in the most complex procedures, including those with vascular and contiguous organ invasion.