Vol.:(0123456789) 1 3 Journal of Robotic Surgery https://doi.org/10.1007/s11701-020-01158-4 ORIGINAL ARTICLE Feasibility, safety and efcacy of argon beam coagulation in robot‑assisted partial nephrectomy for solid renal masses ≤ 7 cm in size Kayhan Tarim 1  · Mert Kilic 2  · Ersin Koseoglu 3  · Abdullah Erdem Canda 1  · Yakup Kordan 1  · Mevlana Derya Balbay 1,2  · Omer Acar 1  · Tarik Esen 1,2 Received: 20 July 2020 / Accepted: 5 October 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020 Abstract One of the most important steps of the partial nephrectomy (PN) is hemostatic control of tumor bed which also efects the warm ischemia time (WIT). Argon beam coagulation (ABC) for decades is a well-known method for surface controls during major open surgical sites. This study aimed to compare peri- and postoperative relevant parameters in patients with ABC or internal renorrhaphy (IR) during robot-assisted partial nephrectomy (RAPN). One hundred seventy patients with ≤ 7 cm tumors, who underwent RAPN at our institutions, were included in this retrospective study. Tumor bed was controlled by either IR or by ABC after closing isolated overt collecting system defects. No additional IR was performed in patients with ABC. Estimated blood loss (EBL), WIT, estimated glomerular fltration rate (eGFR) change, on- vs. of-clamp procedure as well as Clavien-Dindo > 2 complications in both groups were compared. Eighty-seven (51.1%) patients had ABC and 83 (48.9%) had IR as their tumor bed control method. Tumor size, side and RENAL nephrometry score in both groups were similar. Mean warm ischemia time (WIT) was 20.8 min in ABC group and 23.8 min in IR group (p = 0.03). In 4–7 cm tumors, WIT was 19.9 min in ABC group while 26.6 min in IR group (p = 0.026). eGFR change from baseline and EBL favored ABC in entire cohort as well as in 4–7 cm tumors with statistical signifcance. There were more of-clamp procedures with ABC in ≤ 4 cm tumors. No ABC specifc complications were observed. Within 2 years of follow-up, no patient developed recur- rences. The control of the tumor base with ABC during RAPN shortens the warm ischemia times signifcantly compared to IR. Besides, ABC had better EBL and GFR changes outcomes. With close monitoring of intra-abdominal pressure and frequent venting, disturbing complications of ABC could completely be avoided. ABC was found to be feasible, safe and efective during RAPN. Keywords Robot-assisted partial nephrectomy · Renal cancer · Argon beam coagulation · Renorrhaphy · Warm ischemia time Introduction Most of the small solid renal tumors today are detected inci- dentally making them amenable to nephron sparing surgery (NSS), which has a clear advantage over radical nephrec- tomy (RN) in preserving renal function and increasing overall survival, especially for cT1a tumors [1–3]. Func- tional and oncological outcomes of laparoscopic, robotic and open partial nephrectomies do not difer signifcantly for ≤ 4 cm masses [4]. In a median 5 years of follow-up, local recurrence-, distant metastasis- and cancer-related death rates were similar in all three techniques [4]. One of the critical steps of this demanding surgery is the need for warm ischemia and the resulting challenge of completing Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11701-020-01158-4) contains supplementary material, which is available to authorized users. * Kayhan Tarim ktarim@ku.edu.tr 1 Department of Urology, School of Medicine, Koç University, 34010 İstanbul, Turkey 2 Department of Urology, VKF American Hospital, 34365 Istanbul, Turkey 3 Department of Urology, Koç University Hospital, Istanbul, Turkey