ROBOTIC-ASSISTED SIMPLE ENUCLEATION FOR THE TREATMENT OF CLINICAL T1 RENAL MASSES: SINGLE-CENTER EXPERIENCE

Scopo del lavoro The simple enucleation is a technique of nephron sparing surgery that excides the tumor surrounded by no visible rim of healthy parenchyma. The aim of the study was to report the feasibility and perioperative outcomes of endoscopic robotic-assisted simple enucleation (ERASE) performed at our institution. Materiali e metodi Between January 2010 and January 2013, 130 consecutive patients had ERASE for suspicious solid renal lesions. Clinicopathologic variables, nephrometry scores, perioperative parameters, and renal functional outcomes were prospectively recorded and analyzed. Risultati Mean (± SD) tumor size was 3.2 cm (± 1.5). Median PADUA score was 8; 42 (32,3%) tumors had PADUA ≥ 8, and 10 (7,7%) had PADUA ≥ 10. Overall, 101 (77.7%) tumors were clinically T1a, 29 (22.3%) T1b. 30 (23.1%) cases were performed without clamping the hilum or renal artery, while a super selective arterial branches clamping was done in 14 (10,8%) cases. In 66.1% of cases the main renal artery/renal pedicle was clamped and mean warm ischemia time (WIT) was 18 minutes (±6). A WIT ≥ 25 minutes was necessary in 21 cases (16.2%). The median operative time was 157 min (±54). The median blood loss was 119 mL. Postoperative surgical complications were reported in 11 (8.6%) patients and of those, 6 (4.7 %) were major complications according to the Calvien-Dindo classification. No urinary fistulas occurred in this series. The mean ΔHb was 2.2g/dL and the mean Δ serum creatinine was 0.06 mg/dL. Histopathologic analysis revealed 107 (82.3%) renal cell carcinomas and 23 (17.7%) benign tumors. Positive surgical margins were observed in 3 cases (2.3%). Pathological T stage was pT1a in 70 (65,4%) cases, pT1b in 25 (23,4%), pT2a in 1 (0,9%), pT3a in 11 (10,3%). Discussione The robotic surgical system may enable faster and greater technical proficiency, facilitating a minimally invasive approach to more difficult lesions while reducing ischemia time. Conclusioni Robotic approach enhances the phase of enucleation and keeps the field less bloody. The vision magnification allows a more accurate identification of small vessels, that can be readily coagulated during enucleation. This makes ERASE a feasible and safe technique associated with a low incidence of surgical complications, low risk of urinary fistulas and lower positive surgical margin rate.