2-II. Cornerstones of enucleative partial nephrectomy A. Minervini

In summary, the cornerstones of robot-assisted enucleative partial nephrectomy are:
 

• Accurate delineation of the tumor contours, with or without the use of intraoperative ultrasound once a radial nephrotomy 2-3 mm away from the lesion towards the peritumoral margins has been made.
• Research of the anatomic dissection plane.
• Development of the anatomic dissection plane predominantly by blunt dissection with strategic use of electrocautery creating a relatively bloodless, radially oriented surgical field.
• Development of gentle, dynamic, coordinated tractions using the two robotic arms to lift the tumor off the resection bed around the whole circumference of the tumor-parenchyma interface.
• Coordination between the surgeon and the bedside assistant: the proper use of the suction device allows for a) transient compression of any bleeding vessel during the development of the anatomic plane; b) increase of the exposition through a dynamic, delicate traction on the renal parenchyma and c) a bloodless surgical field. 6. Selective point-specific hemostasis on the resection bed, closing any possible defect of the urinary collecting system. 
• Accurate, anatomic renal reconstruction, avoiding compressive parenchymal whip stitches