Conventional laparoscopy and da Vinci robot-assisted technique for partial nephrectomy: comparison of indications and clinical outcomes

Abstract

Objective To investigate the clinical benefits and role of robot-assisted laparoscopic partial nephrectomy(RAPN) by comparing the clinical data of patients receiving the RAPN or conventional laparoscopic partial nephrectomy(CLPN).MethodsA retrospective analysis was performed for 67 patients who underwent either RAPN(n =24) or CLPN (n =43) between January 2011 and December 2012 at our institution.Preoperative clinical stages of both groups were T1N0M0.Univariate analysis and logistic regression model were used to detect factors affecting indication selection in RAPN.The intraoperative parameters and postoperative outcomes were compared between RAPN and CLPN groups matched for DAP score.ResultsUnivariate and multivariate logistic regression analysis revealed that DAP score(β =1.987,P =0.022,95%CI[1.34,39.79]) was the only predictor of RAPN approach in logistic regression analysis.Only 38 DAP matched cases in RAPN(n =19) and CLPN(n =19) were included for analysis,and the demographics were comparable between the matched two groups except for the preoperative estimated glomerular filtration rate(eGFR).One open conversion was required in the RAPN group due to intra-operation bleeding,and all the cases were smoothly completed in the conventional laparoscopic group.There were no significant differences between the matched two groups regarding the estimated blood loss,time off oral-intake,highest visual analog pain scale,length of stay,complication rate or transfusion rate(all P 0.05).Patients undergoing RAPN had a significantly shorter warm ischemia time([27.0±5.3] min vs [34.2±7.3] min,P 0.05) and a longer operative time([249.5±49.6] min vs [212.9±57.11] min,P 0.05) compared with CLPN group.The surgical margins were negative in both groups.During a mean follow-up of(5.6±2.2) months and(6.6±2.6) months,only one tumor recurrence was notice in the CLPN group.At the last follow-up,the decrease percentage of eGFR was(12±8)% in the RAPN group versus(17±15)% in the CLPN group(P 0.05).ConclusionRAPN requires a shorter warm ischemia time and provides a more rapid learning curve,good surgical safety and good short-term efficacy.For surgeons with experienced CLPN technique,they can use RAPN to treat high-complexity tumors which are beyond the conventional laparoscopic technique.