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Summary: Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53cm. The median operative time was 198min and warm ischaemia time (WIT) 30min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low–moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor. [ABSTRACT FROM AUTHOR]

Summary: There has been much interest in the volume–outcome relationship within surgical specialities and the potential impact on service reconfiguration. Recent research has raised questions about the validity of the methodology used in existing volume–outcome studies. This review explores a methodological framework for assessing the volume–outcome relationship and discusses limitations of previous research. In particular reference is made to the existing urological literature in this field. Areas for improvement and the potential for future research are considered. [Copyright &y& Elsevier]

A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation. [ABSTRACT FROM AUTHOR]

Objectives: Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer.Patient and Methods: We utilized the National Cancer Database (2005-2010) to identify 14,677 patients (immediate nephrectomy: 14,050 patients vs. late nephrectomy: 627 patients) aged <70 years with Charlson Comorbidity Index 0 and cT1aN0M0 renal cell carcinoma. Immediate nephrectomy and late nephrectomy were defined as nephrectomy performed <30 days and >180 days from diagnosis, respectively. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the 2 treatment arms. Influence of patient age and Charlson Comorbidity Index on treatment effect was tested by interactions. Sensitivity analysis was performed to explore the outcome of delaying nephrectomy for >12 months.Results: Median patient age was 55 years with a median follow-up of 82.5 months. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves suggest no significant difference between treatment arms (immediate nephrectomy [<30 days] vs. delayed nephrectomy [>180 days]) (Hazard ratio 0.96; 95% confidence interval 0.73-1.26; P = 0.77). This outcome was consistent between all patients regardless of age (P = 0.48). Sensitivity analysis reports no difference in OS even if nephrectomy was delayed by >12 months (P = 0.60).Conclusions: We report that delayed and immediate nephrectomy for cT1a renal cell carcinoma confers comparable long-term OS. These findings suggest that a period of observation of between 6 and 12 months is safe to allow identification of renal masses, which will benefit from surgical resection. [ABSTRACT FROM AUTHOR]