Robotic Radical Nephrectomy for Massive Renal Tumors

Introduction: The role of robotic surgery in radical nephrectomy is controversial with detractors claiming no benefit over standard or hand-assisted laparoscopic nephrectomy with increased cost. We routinely offered robotic radical nephrectomy (RRN) for all renal masses not amenable to partial nephrectomy regardless of size or complexity and evaluated the success rate for massive tumors (>= 15cm) to assess whether RRN may be justifiable in such cases. Methods: We reviewed our prospective database of RRN by an experienced robotic surgeon (R.A.). All patients with massive renal tumors (>= 15cm) were included without exclusions, and no nephrectomy procedures were performed laparoscopically or open approach by the surgeon such that there was no selection bias. Results: Fifteen patients had tumors of 15-30cm (mean 19cm) and underwent RRN without exclusions. Mean age was 62 years (35-78 years) with mean body mass index of 31kg/m(2) (21-41kg/m(2)). One required partial liver resection, one splenectomy and distal pancreatectomy, one had a large caval thrombus, one a large renal vein thrombus, and one invaded psoas muscle, but all were completed robotically without conversions and no transfusions, with mean operative time of 235 minutes (72-337 minutes). Midline extraction incisions were used and no patients required intravenous narcotics. Twelve were discharged on the first postoperative day (80%) with median length of stay of 1 day and no 90-day readmissions. The only complication was temporary renal insufficiency in 1 patient. Conclusions: RRN for massive renal tumors (>15cm) is feasible, and can be safely performed with excellent outcomes even in the setting of locally advanced malignancies.