Medial versus lateral camera port placement for robotic nephron-sparing surgery: evaluating surgical complications and outcomes.

Abstract

As the growing popularity of robotic-assisted laparoscopic procedures for the treatment of renal cancer increases, there exists a variation in surgical technique among institutions and surgeons alike. One variation that exists in robotics is the anatomical placement of the camera port (medial versus lateral camera port placement). The purpose of this study is to evaluate surgical complications and outcomes in comparison to site of camera port placement during nephron-sparing surgery in an academic setting. Over a three-year period, outcomes for all robotic surgeries for renal cancer were examined. A total of 229 cases were discovered. Patient demographics and comorbidities were analyzed along with perioperative surgical data including location of camera port, surgery length, warm ischemia time, blood loss, pathological tumor margins, tumor size, length of stay and laboratory data. 134 patients had surgery performed with lateral camera port placement versus 95 patients with medial camera port placement. Operative time was significantly lower with an average operative time of 165.8min for the lateral group versus 209.1min in the medial group (p < 0. 0001). Warm ischemia time was also less in the lateral group with an average of 11min versus 15.5min for the medial group (p < 0. 0001).Blood loss was less in the lateral camera port group with an average of 158.2mL (± 196.5mL) versus 248.6mL in the medial group (± 252.6) (p = 0.0040). Drain use, positive surgical margin rate, transfusion rate, conversion to radical nephrectomy, change in pre-operative versus postoperative creatinine and glomerular filtration rate and length of hospital stay did not statistically differ. Lateral camera port placement is associated with decreased operative time and warm ischemia time in this series. There may be certain laparoscopic advantages through a better visualization of surgical anatomy, thus allowing for faster extirpation of renal lesions and decrease in surgical time. These advantages may result in better long-term renal function and decreased clinical sequela from chronic kidney disease.