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Positioning and pneumoperitoneum can adversely impact upon patients with cardiopulmonary disease by compromising ventilation and venous return. Patients with chronic pulmonary disease may not be able to compensate for the pneumoperitoneum-induced hypercarbia and may require working at lower pressures, use of helium as an insufflant, or open conversion [18]. Patients with poor cardiac function, significant aortic stenosis, low ejection fractions, severe restrictive lung disease, or poor pulmonary function tests must be cleared by appropriate specialists or in some cases may be better served with an open operation.

Anatomical imaging such as contrast-enhanced abdominal and pelvic CT or MRI should be ordered to carefully characterize any known lesions, adenopathy, and/or hilar challenges such as anomalous or multiple renal vessels [16]. Preoperatively, patients should have a basic metabolic panel; complete blood count, type, and screen; and coagulation profile checked. For patients with comorbidities or 27 age-indicated indications, a baseline chest X-ray and EKG should also be obtained. Older patients or patients with comorbidities may need clearance by a cardiologist or pulmonologist.

15. 16. safety: a multicenter experience. Urology. 1998;52(5): 773–7. Okeke AA, Timoney AG, Keeley FX. Hand-assisted laparoscopic nephrectomy: complications related to the hand-port site. BJU Int. 2002;90(4):364–7. Hemal AK, Menon N, editors. Robotics in genitourinary surgery. 1 ed. London: Springer; 2011. Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes.

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