Minimally invasive partial nephrectomy in the era of robotic surgery

Abstract

A t present, European Association of Urology guidelines strongly recommend partial nephrectomy (PN) [1] for cT1 renal masses. [2] PN can be performed, either with an open, laparoscopic, or robotic-assisted approaches. The basic principles of modern PN were first reported by Vermooten in 1950. [3] Laparoscopic PN (LPN) was first introduced by Win-field et al. in 1993. [4] With the introduction of robotic systems in surgical procedures, Gettman et al. published the first robotic-assisted PN (RPN) series in 2004. [5] The rate of PN for treatment of renal masses has increased over time. [6] Nowadays, the rate of renal masses incidentally diagnosed constitutes more than half of all renal masses. [7] As a result of this, surgical interventions for small renal masses have increased. This trend was followed by raise of interest in minimally invasive surgery in effort to reduce morbidity and hospitalization time and expedite recovery after surgery. [8] Various studies have been conducted to investigate the impact of different approaches of PN on perioperative Objectives: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). Methods: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN. Results: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glo-merular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively). Conclusion: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.