Background/significance:

We review our early experience in robotic assisted partial nephrectomy.

Partial nephrectomy is evolving as the standard of care for the surgical management of small renal masses.

The goal of minimally invasive surgery is equivalent oncological outcome, with reduced operative morbidity, and length of stay.

Objectives:

1. Review the volume of surgery being performed

2. Look at procedure specific key performance indicators of oncological clearance, and warm ischemia time

3. Assess the complexity of surgery being performed, utilising renal nephrometry scores

4. Assess complications

5. Assess the impact of robotics on operative technique

Methods:

A prospectively maintained database, and video library of each case was reviewed to attain relevant data.

The pathology for each case was reviewed in the MDT setting to confirm histology and margin status

Complications were graded using the modified Clavien Dindo classification system

Renal nephrometry scores were determined on pre-operative imaging

Results:

Between 2010 ans 2013 32 cases were performed

Average tumour size was 30 mm

Mean length of stay 3 days

Greater than 70% of cases were of moderate or high complexity

Median operative time was 140 minutes

Median blood loss was 80 ml, mean 145ml

Median warm ischaemia time16 minutes

Transfusion rate 0%, Conversion to open 0%

Negative margin rate 100%

Local recurrence 0%

2 Complications: 1 stent inserted for haematuria, and single NSTEMI.

15% benign lesions

Conclusion:

Early experience demonstrates robotic-assisted partial nephrectomy to be a safe option for the surgical management of small renal masses

0% surgical margin rate, with two complications suggests early safety with minimal morbidity

Review of operative times show significant improvement with experience, as does warm ischaemia time

We submit this data for review, as one of Australias largest series of robotic assisted partial nephrecomy, and contend that robotics allows more complex lesions to be managed with renal preservation and minimally invasive surgery