Presentation Authors: David Goldrath, Richard Troy, Barrington, IL, Charles Loeb*, Orange, CA, Roger Khouri, Dallas, TX
Introduction: The purpose of our study is to report on our experience with radiofrequency ablation-assisted, clampless, robotic partial nephrectomy (RFA-CRPN), which allows for intraoperative pathology evaluation without concerns for warm ischemia time (WIT).
Methods: 187 consecutive patients with 195 renal masses T1a-T2b underwent RFA-CRPN with intraoperative pathology evaluation. Average R.E.N.A.L. nephrometry score was 7.0. Intraoperative ultrasound was used to delineate the mass and renal parenchymal thickness. The Habib 4x radiofrequency ablator with the 1500 Rita generator was used to establish a 1-cm zone of coagulation around the mass. Sharp dissection and bipolar cautery was used to excise the mass. Frozen section confirmation of margin status was obtained in all cases.
Results: All masses were excised without the need for vascular clamping. Median operative time was 184 minutes; median blood loss was 150 mL. A negative surgical margin was obtained in all malignant cases. Four of 187 patients had urine leaks, which were managed with either prolonged percutaneous drainage or ureteral stent placement. We observed no significant change in long term (>24 months) renal function compared to preoperative levels (p=0.052). Radiographic follow up available in 171 patients showed no local tumor recurrences, strictures, or hydronephrosis.
Conclusions: Our study demonstrates the feasibility of performing a truly clampless robotic partial nephrectomy. Our technique allows the surgeon to operate in a nearly bloodless field without the time constraints imposed by renal vasculature clamping. This technique minimizes nephron loss, eliminates WIT, and results in a very low urinary leak rate while allowing for confirmation of negative intraoperative surgical margins.