Robot-assisted laparoscopic partial nephrectomy: the NYU technique.

The introduction of the daVinci surgical system has changed the way both surgeon and patient view radical prostatectomy. We hypothesized that the same theoretical and tangible benefits may be realized when employing the system for partial nephrectomy. This paper reviews our technique of robot-assisted laparoscopic partial nephrectomy (RALPN) utilizing the daVinci surgical system. Intraoperative hilar clamping is utilized in all cases. With the daVinci system, the tumor is excised with cold scissors, biopsies are taken from the base for frozen-section study, sutures are placed at the base, Gelfoam/fibrin glue is activated in the defect, a Surgicel bolster is laid in the defect, and mattress sutures are placed prior to releasing the clamp. After performing 12 RALPNs, it appears this technique is safe, feasible, and reproducible both for small exophytic masses and for deeper lesions involving the collecting system. A RALPN requires two surgeons, both well versed in laparoscopic and robotic techniques.