Journal of Robotic Surgery

, Volume 12, Issue 4, pp 679–685 | Cite as

Nephrometry score matched robotic vs. laparoscopic vs. open partial nephrectomy

  • Pooya Banapour
  • George A. Abdelsayed
  • Zoe Bider-Canfield
  • Peter A. Elliott
  • Patrick S. Kilday
  • Gary W. ChienEmail author
Original Article


To compare perioperative outcomes in the three most common partial nephrectomy modalities: robotic (RPN), laparoscopic (LPN), and open (OPN), matched for nephrometry scores. Patients aged 16–85 who underwent RPN, LPN, or OPN from 2007 to 2014 for localized renal carcinoma within our healthcare system were enrolled. Age, sex, body mass index, and Charlson Comorbidity Index (CCI) as well as perioperative outcomes of estimated blood loss (EBL), length of hospital stay (LOS), ischemia time (IT), change in eGFR, positive margin rate, operative time (OT), and emergency room visit rates were compared between RPN, LPN, and OPN using the R.E.N.A.L nephrometry score. A total of 862 patients underwent partial nephrectomy (523 LPN, 176 OPN, and 163 RPN). Patients who underwent OPN were significantly older, and had higher nephrometry scores and CCI. When matched for nephrometry scores, minimally invasive (LPN and RPN) compared to OPN had lower EBL (< 0.0001), shorter LOS (< 0.0001), shorter IT (< 0.001), and less change in eGFR (< 0.001), particularly in nephrometry scores higher than 8 (0.0099). Comparing RPN with LPN, RPN had significantly shorter OT in all nephrometry scores (< 0.001); shorter IT and LOS in nephrometry scores higher than 7. Our study suggests that minimally invasive partial nephrectomy may have superior outcomes to OPN when matched by nephrometry scores, particularly at higher scores and for RPN. This finding may contribute to a surgeon’s decision in the approach to partial nephrectomy.


Laparoscopy Nephrectomy Renal cancer Robotic Surgical procedures 



Body mass index


Charlson Comorbidity Index


Computed tomography


Current Procedural Terminology


Electronic medical record


Estimated blood loss


Estimated glomerular filtration rate


Ischemia time


Kaiser Permanente Southern California


Laparoscopic partial nephrectomy


Length of hospital stay


Magnetic resonance imaging


Minimally invasive partial nephrectomy


Open partial nephrectomy


Operative time


Robotic-assisted partial nephrectomy


Emergency room


Compliance with ethical standards

Conflict of interest

Pooya Banapour, George A. Abdelsayed, Zoe Bider-Canfield, Peter A. Elliott, Patrick S. Kilday, and Gary W. Chien declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30CrossRefGoogle Scholar
  2. 2.
    Campbell SC, Novick AC, Belldegrun A (2009) Guideline for management of the clinical stage 1 renal mass. J Urol 182:1271–1279CrossRefGoogle Scholar
  3. 3.
    Boger M, Lucas SM, Popp SC, Gardner TA, Sundaram CP (2010) Comparison of robot-assisted nephrectomy with laparoscopic and hand-assisted laparoscopic nephrectomy. JSLS 14:374–380CrossRefGoogle Scholar
  4. 4.
    Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46CrossRefGoogle Scholar
  5. 5.
    Gong EM, Orvieto MA, Zorn KC, Lucioni A, Steinberg GD, Shalhav AL (2008) Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol 22:953–957CrossRefGoogle Scholar
  6. 6.
    Kercher KW, Heniford BT, Matthews BD et al (2003) Laparoscopic versus open nephrectomy in 210 consecutive patients: outcomes, cost, and changes in practice patterns. Surg Endosc Other Intervent Tech 17:1889–1895CrossRefGoogle Scholar
  7. 7.
    Lucas SM, Mellon MJ, Erntsberger L, Sundaram CP (2012) A comparison of robotic, laparoscopic and open partial nephrectomy. JSLS 16:581–587CrossRefGoogle Scholar
  8. 8.
    Minervini A, Vittori G, Antonelli A et al (2014) Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications. World J Urol 32:287–293CrossRefGoogle Scholar
  9. 9.
    Sprenkle PC, Power N, Ghoneim T et al (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61:593–599CrossRefGoogle Scholar
  10. 10.
    Zheng JH, Zhang XL, Geng J et al (2013) Long-term oncologic outcomes of laparoscopic versus open partial nephrectomy. Chin Med J (Engl) 126:2938–2942Google Scholar
  11. 11.
    Masson-Lecomte A, Yates DR, Hupertan V et al (2013) A prospective comparison of the pathologic and surgical outcomes obtained after elective treatment of renal cell carcinoma by open or robot-assisted partial nephrectomy. Urol Oncol 31:924–929CrossRefGoogle Scholar
  12. 12.
    Kutikov A, Uzzo RG (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefGoogle Scholar
  13. 13.
    Simhan J, Smaldone MC, Tsai KJ et al (2012) Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol 187:2000–2004CrossRefGoogle Scholar
  14. 14.
    Wu Z, Li M, Qu L et al (2014) A propensity-score matched comparison of perioperative and early renal functional outcomes of robotic versus open partial nephrectomy. PLoS ONE 9:e94195CrossRefGoogle Scholar
  15. 15.
    Gin GE, Maschino AC, Spaliviero M, Vertosick EA, Bernstein ML, Coleman JA (2014) Comparison of perioperative outcomes of retroperitoneal and transperitoneal minimally invasive partial nephrectomy after adjusting for tumor complexity. Urology 84:1355–1360CrossRefGoogle Scholar
  16. 16.
    Sammon JD, Karakiewicz PI, Sun M et al (2013) Robot-assisted vs. laparoscopic partial nephrectomy: utilization rates and perioperative outcomes. Int Braz J Urol 39:377–386CrossRefGoogle Scholar
  17. 17.
    Lee S, Oh J, Hong SK, Lee SE, Byun SS (2011) Open versus robot-assisted partial nephrectomy: effect on clinical outcome. J Endourol 25:1181–1185CrossRefGoogle Scholar
  18. 18.
    Orvieto MA, Chien GW, Tolhurst SR, Rapp DE, Steinberg GD, Mikhail AA, Brendler CB, Shalhav AL (2005) Simplifyng laparoscopic partial nephrectomy: technical considerations for reproducible outcomes. Urology 66:976–980CrossRefGoogle Scholar
  19. 19.
    Funahashi Y, Yoshino Y, Sassa N, Matsukawa Y, Takai S, Gotoh M (2014) Comaprison of warm and cold ischemia on renal function after partial nephrectromy. Urology 84:1408–1412CrossRefGoogle Scholar
  20. 20.
    Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME (2011) Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology 78(813–9):20Google Scholar
  21. 21.
    Xu H, Ding Q, Jiang HW (2014) Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system—a retrospective analysis from southern China. World J Surg Oncol 12:242CrossRefGoogle Scholar
  22. 22.
    Yu HY, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC (2012) Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 187:1392–1398CrossRefGoogle Scholar
  23. 23.
    Mullins JK, Feng T, Pierorazio PM, Patel HD, Hyams ES, Allaf ME (2012) Comparative analysis of minimally invasive partial nephrectomy techniques in the treatment of localized renal tumors. Urology 80:316–321CrossRefGoogle Scholar
  24. 24.
    Jabaji R, Fischer H, Kern T, Chien GW (2018) Trend of surgical treatment for localized renal cell carcinoma in a large population (manuscript submitted for publication)Google Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyKaiser Permanente Los Angeles Medical CenterLos AngelesUSA
  2. 2.Department of Research & EvaluationKaiser PermanentePasadenaUSA

Personalised recommendations