- Prof. Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
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Special Issue Introduction
Partial nephrectomy (PN) aims to preserve renal function with fewer complications but similar oncological outcomes to radical nephrectomy. Since chronic kidney disease (CKD) is associated with cardiovascular events that can decrease survival, PN is used to prevent CKD in patients with normal kidney function or bilateral kidneys and prevent the need for renal replacement therapy in patients with CKD or a solitary kidney.
Minimally invasive surgery such as laparoscopic surgery is now performed in many surgical fields, and the advent of robotic surgery has accelerated its popularity. The utilization of robotic PN (RPN) has increased year by year despite differences in race or insurance. Although RPN and open PN (OPN) share the same ultimate goal, the outcomes vary among approaches used, surgeons’ skills, and tumor-related factors.
RPN provides surgeons with a clear field of vision and delicate maneuverability, resulting in precise tumor resection and preservation of the kidney parenchyma. This minimal invasiveness facilitates an earlier recovery. However, the limited working space creates difficulty in cases of large tumors or a history of repeated abdominal surgeries. In addition, most RPN procedures feature warm ischemia, which limits ischemic time to avoid irreversible kidney injury. On the other hand, OPN can adequately cool the kidney, enabling the surgeon to work through an extended ischemic time; however, even then, large incisions made in the skin and muscle may result in a slower postoperative recovery.
Many articles have compared the surgical outcomes of OPN and RPN in several settings. We also compared the surgical outcomes of patients with CKD, showing that the two approaches featured similar functional and perioperative complications with a shorter hospital stay and lower estimated blood loss with RPN despite its limited use to that point. However, these results showed that an optimal patient selection is key, as not all patients achieved the same results. This finding may be compatible with those of other retrospective studies.
In this special edition of Comparison of Perioperative Outcomes of Open and Robotic Partial Nephrectomy, specialists provide plenty of data regarding RPN and OPN and discuss the benefits and drawbacks of them. We expect that the information contained herein will help surgeons optimize the use of PN for treating renal tumors.
KeywordsMinimally invasive surgery, kidney tumor, partial nephrectomy
Submission Deadline15 Nov 2020