Nephron-sparing surgery: our experience.

Objectives: To analyze the data of our department with regard to the treatment of kidney cancer, with particular attention to nephron-sparing surgery (NSS). Data of initial experience on robot-assisted partial nephrectomy (RAPN) were also analyzed. Methods: Between January 2005 and December 2010, at the Urology Clinic of Padua, 780 procedures for kidney cancer were performed: 462 radical nephrectomies (RN), 289 open partial nephrectomies (OPN), and 29 robot-assisted partial nephrectomies (RAPN). Between January 2010 and July 2011 41 RAPN as well as 38 OPN were performed. Results: The average volume of tumors treated with RAPN was 2.17 cm, 1.98 cm, and 2.78 cm in the first, second, and third half-year, respectively. The mean operative time was 220 minutes, 200 minutes, and 180 minutes in the first, second, and third half-year, respectively. The average warm ischemia time was 24 minutes, 22 minutes, and 21 minutes in the first, second, and third half-year, respectively. The average estimated blood loss was 170 mL, 160 mL, and 180 mL in the first, second, and third half-year, respectively. In the same period, the average volume of tumors treated with OPN was 3.7 cm, 3.9 cm, and 5.7 cm respectively in the first, second, and third half-year. Conclusions: We have observed a gradual extension of the indications for NSS. The systematic application of robotic surgery has allowed for the treatment of even more complex cases with relatively low learning curve. OPN has therefore become a technique that should be reserved for more complex cases.