The Feasibility And Safety Of Robot-Assisted Modified Enucleation For Highly Complex Renal Tumors 4–7 Centimeters: Research On A Surgical Technique

Background: In recent years,with the widespread use of imaging techniques in medical examinations,the diagnostic rate of localized renal tumors has increased.Although partial nephrectomy has become the standard procedure for localized renal tumors,this procedure is still difficult to treat highly complex localized renal tumors.With the introduction of robotic surgery,the use rate of robot-assisted partial nephrectomy has increased year by year,and this approach may become the standard surgical procedure for complex localized renal tumors.Objectives: To report the technical feasibility and oncological safety of Robot assist enucleation for highly complex renal tumors 4–7 centimeters using combined retroperitoneoscopic and transperitoneoscopic accesses.Subjects and Methods: The present research is a retrospective analysis of 105 cases highly complex renal tumors underwent conventional robot-assisted partial nephrectomy(C-RAPN)at a tertiary academic institution between September 2014 and December 2017.Consecutive consented patients were grouped into two cohorts: 51 cases underwent conventional robot-assisted partial nephrectomy(C-RAPN),and 54 cases performed with modified endoscopic robot-assisted tumor enucleation(MERATE).Perioperative and oncological outcome of both groups were reported.Furthermore,pathological examination ofhighly complex renal tumors 4–7 centimeters was analyzed.Results: Although preoperative clinical data were similar between two groups,perioperative outcomes were distinctly different.Kidney function and hemoglobin level at postoperative day 1 were better(p = 0.003 and p=0.001,respectively),and surgical margin width was narrower(1.98 vs 4.98mm;p <0.001)in MERATE group.In addition,MERATE group presented less blood loss(155 and 88 ml;p = 0.001),lower 30-d complication rates(3.8% and 21.5%,respectively;p=0.041).Moreover,mean ischemia time and operative time were 4 and 13 minutes shorter in MERATE group,respectively.Finally,histopathological analysis of the 112 stage p T1 b renal tumors provides objective evidence for feasibility of MERATE.Conclusion: MERATE technology may offer an efficient and safe method to anatomically dissect challenging renal tumor in referral centers.The long-term outcome of MERATE technology merits further investigation.