Initial experiences with robot-assisted partial nephrectomy

Introduction: Malignant tumors of the kidney are being detected more often at an early stage thanks to more frequent abdominal ultrasound examinations. Robot-assisted partial nephrectomy is a nephron-sparing treatment option for localized kidney cancer, which has been available in Hungary since 2022. Objective: Summarizing, evaluating and publishing our initial experiences with robot-assisted partial nephrectomy surgery. Method: Retrospective study of robot-assisted partial nephrectomy surgeries. An overview of the preoperative characteristics of the patients who underwent surgery and their tumors, the surgical parameters and complications, and the histological results of the removed tumors. Results: Between June 2022 and March 2024, 78 robot-assisted partial nephrectomy surgeries were performed. The tumors had a low PADUA score in 59% and an intermediate and high PADUA score in 41%. The average operation time was 123 minutes, the average ischemic time was 18 minutes. Clavien-Dindo II and III complications occurred in 2 cases each. Conversion took place in one case. There was no reoperation. Patients were discharged on average on the second postoperative day. The tumors were malignant in 80%. The surgical margin was positive in 10%. Discussion: Robot-assisted partial nephrectomy is a suitable treatment for organ-confined, complex kidney tumors. Its functional outcomes are better than those of open surgery. It has fewer perioperative complications than open and laparoscopic surgeries. Its oncological outcome is the same as that of open and laparoscopic surgeries. During the learning curve, warm ischemia and console time are optimized after 20 surgeries. To maintain the results, it is necessary to perform at least 18-20 cases per year. Conclusion: Robot-assisted partial nephrectomy is a minimally invasive procedure with good results that can be used safely in the treatment of malignant kidney tumors.