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Comparisons of surgical outcomes between transperitoneal and retroperitoneal approaches in robot-assisted laparoscopic partial nephrectomy for lateral renal tumors: a propensity score-matched comparative analysis

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Abstract

Objective

To compare the surgical outcomes between the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted laparoscopic partial nephrectomy (RAPN) for lateral tumors.

Methods

This study included patients who underwent RAPN for lateral renal tumors between 2013 and 2019. Lateral tumors were defined as X of A factors in the RENAL nephrometry score. In total, 290 and 48 patients with TP and RP, respectively, were included in the analysis. To minimize the effects of selection bias, the following variables were adjusted using 1:1 propensity score matching: age, sex, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate, tumor size, and RENAL nephrometry score.

Results

After matching, 48 patients were allocated to each group. The mean age was 55 years, and the mean preoperative estimated glomerular filtration rate (eGFR) was 68–69 mL/min/1.73 m2. The mean tumor size was 30–31 mm. The RP group had a shorter operative time (124 vs. 151 min, p = 0.0002), shorter console time (74 vs. 110 min, p < 0.0001), shorter warm ischemic time (14 vs. 17 min, p = 0.0343), lower estimated blood loss (EBL) (33 vs. 52 ml, p = 0.0002), and shorter postoperative length of hospital stay (PLOS) (3.3 vs. 4.0 days, p < 0.0001) than the TP group. The change in eGFR, incidence rate of perioperative complication, and positive surgical margin rate did not significantly differ between the two groups.

Conclusion

RP had better surgical outcomes, including shorter operative time, lower EBL, and shorter PLOS for lateral renal tumors, which may suggest that RP is the optimal approach for selected lateral renal tumors.

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Abbreviations

RAPN:

Robot-assisted partial nephrectomy

RP:

Retroperitoneal approach

TP:

Transperitoneal approach

eGFR:

Estimated glomerular filtration rate

RENAL-NS:

RENAL nephrometry score

EBL:

Estimated blood loss

BMI:

Body mass index

PLOS:

Postoperative length of hospital stay

WIT:

Warm ischemic time

ASA:

American Society of Anesthesiologist

RAP:

Renal artery pseudoaneurysm

TAE:

Transarterial embolization

References

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Acknowledgements

We thank Ms. Nobuko Hata for providing administrative assistance.

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Authors and Affiliations

  1. Department of Urology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Toshio Takagi, Kazuhiko Yoshida, Tsunenori Kondo, Hirohito Kobayashi, Junpei Iizuka, Masayoshi Okumi, Hideki Ishida & Kazunari Tanabe

Authors
  1. Toshio Takagi
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  2. Kazuhiko Yoshida
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  3. Tsunenori Kondo
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  4. Hirohito Kobayashi
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  5. Junpei Iizuka
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  6. Masayoshi Okumi
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  7. Hideki Ishida
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  8. Kazunari Tanabe
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Corresponding author

Correspondence to Toshio Takagi.

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The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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5337.

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Takagi, T., Yoshida, K., Kondo, T. et al. Comparisons of surgical outcomes between transperitoneal and retroperitoneal approaches in robot-assisted laparoscopic partial nephrectomy for lateral renal tumors: a propensity score-matched comparative analysis. J Robotic Surg 15, 99–104 (2021). https://doi.org/10.1007/s11701-020-01086-3

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  • DOI: https://doi.org/10.1007/s11701-020-01086-3

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