Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques
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We aimed to evaluate the effect of a transition from laparoscopic partial nephrectomy (LPN) to robotic-assisted laparoscopic partial nephrectomy (RALPN) on peri-operative and oncological patient outcomes. We present the results of the last 50 LPN (group 1) compared with our first 50 RALPN (group 2). The peri-operative data was evaluated using appropriate comparison tests. The parameters compared included operative times, warm ischaemia time (WIT), estimated blood loss (EBL), complications using the Clavien–Dindo (CD) grading system and oncological outcomes including positive surgical margin (PSM) rates. Patients in group 1 (n = 50) and group 2 (n = 50) had comparable pre-operative RENAL scores, ASA scores and tumour size characteristics. Ninety-four percent of the patients in group 1 underwent retroperitoneal LPN while 96 % of patients in group 2 underwent transperitoneal RALP. The mean total operative time in groups 1 and 2 was 163 versus 195 min, respectively (p = 0.003), and EBL was 294 versus 187 ml (p < 0.001). There was no statistically significant difference in WIT between groups 1 and 2 (24.7 and 21.8 min, respectively, p = 0.18). Post-operative histology was comparable in the two groups and the PSM rate was 8 versus 4 % (p = 0.58). The CD major complication rate was 16 % in group 1 versus 4 % in group 2 (p < 0.001). In our series, RALPN appears to have a longer initial total operative time than LPN; however, this reduces after the first 20 cases. RALP has a significant reduction in EBL and post-operative major complication rates, including immediate peri-operative complication rates such as the risk of acute haemorrhage or urinoma. Our data indicates that it is safe to change from LPN to RALPN with no compromise in patient safety or oncological outcomes.
KeywordsRobotic partial nephrectomy Laparoscopic partial nephrectomy Patient outcomes
Conflict of interest
Nikhil Vasdev, Markus Giessing, Hakan Zengini, James M. Adshead and Robert Rabenalt declare that they have no conflict of interest.
- 1.Jewett MA, Mattar K, Basiuk J, Morash CG, Pautler SE, Siemens DR, Tanguay S, Rendon RA, Gleave ME, Drachenberg DE, Chow R, Chung H, Chin JL, Fleshner NE, Evans AJ, Gallie BL, Haider MA, Kachura JR, Kurban G, Fernandes K, Finelli A (2011) Active surveillance of small renal masses: progression patterns of early stage kidney cancer. Eur Urol 60(1):39–44PubMedCrossRefGoogle Scholar
- 5.Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178(1):41–6Google Scholar
- 9.MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, Royle P, Stewart F, MacLennan G, MacLennan SJ, Dahm P, Canfield SE, McClinton S, Griffiths TR, Ljungberg B, N’Dow J, UCAN Systematic Review Reference Group, EAU Renal Cancer Guideline Panel (2012) Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol 62(6):1097–1117PubMedCrossRefGoogle Scholar
- 15.Gill IS, Abreu SC, Desai MM et al (2003) Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol 170: 52–56Google Scholar
- 17.Papalia R, Simone G, Ferriero M, Guaglianone S, Costantini M, Giannarelli D, Maini CL, Forastiere E, Gallucci M (2012) Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes. World J Urol 30(5):671–676PubMedCrossRefGoogle Scholar