Robotic partial nephrectomy, as an alternative to laparoscopic or open partial nephrectomy is still in a fledgling state with few reports and a technique which is not well choreographed. In this series, operative outcomes appear to be excellent, with comparable results to major laparoscopic series and previous small robotic series. [4, 6–11]
Laparoscopic partial nephrectomy has been performed for > 10 years, but still has not gained wide popularity outside of major centers of excellence. The relative rarity of kidney cancer, combined with the advanced technical skills needed to reconstruct the kidney via laparoscopic means, likely have contributed to the challenges in popularizing minimally invasive nephron sparing surgery. Robotic partial nephrectomy has the advantage of making reconstruction of the kidney easier, and thus possibly more available to practicing urologists. Indeed, this is similar to the situation with robotic prostatectomy, which in a short time has gained immense popularity.
Disadvantages of RPN mirror those of LPN as well. The scepter of warm ischemia is ever present, though the "window" of safety is open to debate in the literature. [15–18]
In this series, warm ischemia was not a distinct disadvantage, as the mean warm ischemic time was low overall.
An additional theoretical disadvantage of RPN is the need for an assistant who is capable of comfortably placing instruments near the renal hilum. We found this last issue to be easily overcome, and routinely perform the procedure with residents and assistants of all levels.
Overall, RPN seems to have reasonable results for the treatment of small renal cell carcinomas, but randomized studies comparing it to the pure laparoscopic and open approaches are needed, and long term cancer control outcomes are needed. Cost issues regarding the expense of robotic assistance should also be addressed.