Robotics and Other MIS Approaches for Renal Cell Carcinoma

Historically, open radical nephrectomy was the standard of care for localized renal cell carcinoma (RCC). Over the past three decades, the migration toward early-stage disease overlapped with efforts to improve perioperative morbidity through minimally invasive surgery (MIS), as well as iatrogenic renal impairment by incorporating partial nephrectomy into the treatment paradigm for RCC. Clinical adoption of MIS has expanded to multiple modalities, approaches, and surgical indications while maintaining the guiding principles of open cancer surgery. Today, minimally invasive partial nephrectomy is the standard of care for cT1a (tumors <4 cm) and select cT1b (4–7 cm) disease. For advanced RCC, the movement toward MIS approaches, specifically robotic assistance, has been more cautious. However, early oncologic outcomes in select patients are comparable to open surgery with drastically improved morbidity. This chapter discusses the current robotic and minimally invasive surgical options in the management of localized and advanced kidney cancer, the importance of proper patient selection, and the unique considerations and complications of minimally invasive renal surgery.