BACKGROUND
Robot-assisted transperitoneal access to the kidney is convenient and adequate, and the use of robotic technology often reduces intraoperative blood loss and ischemia time.
OBJECTIVE
Analysis of the results of robot-assisted kidney resection under conditions of «zero» ischemia and with temporary clamping of the renal vessels at the Loginov Moscow Clinical Scientific Center.
MATERIAL AND METHODS
The results of surgical treatment of 43 patients who underwent surgical treatment for renal cancer using the Da Vinci Si robotic surgical system at the Loginov Moscow Clinical Scientific Center for the period from 2016 to 2021.
RESULTS
For 10 (50%) patients, RPN (robotic partial nephrectomy) without ischemia was the method of choice due to initially impaired renal function (decreased creatinine clearance level). It was predominantly performed in patients of low nephrometry evaluation complexity (R.E.N.A.L <=7). Patients who underwent RPN without ischemia had significantly more blood loss compared to patients who underwent RPN with ischemia: 237.5±115.96 ml for RPN without ischemia versus 90±78.4 ml with ischemia (p=0.0153). The duration of the operation was not affected by the absence of clamping of the renal artery (p=0.228) The gradient of decrease in creatinine clearance (CC) was significantly lower in the RRP group without ischemia (3.27±1.04 for the RPN subgroup without ischemia versus 8.74±2.72 for the RPN group with ischemia, p=0.031), which indicates better functional results during RPN without clamping the renal artery. The duration of hospital stay in both groups did not differ (p = 0.189) and amounted to about 4 days, and the number of complications in both groups was single.
CONCLUSION
RPN without ischemia is a safe method of surgical treatment of localized kidney cancer and is preferable for resections of low-grade tumors. RPN without ischemia should preferably be offered to patients with initial renal failure and/or resection of a single kidney to reduce the risk of developing acute renal failure.
