Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques.

Abstract

We aimed to evaluate the effect of a transition from laparoscopic partial nephrectomy (LPN) to robotic-assisted laparoscopic partial nephrectomy (RALPN) on peri-operative and oncological patient outcomes. We present the results of the last 50 LPN (group 1) compared with our first 50 RALPN (group 2). The peri-operative data was evaluated using appropriate comparison tests. The parameters compared included operative times, warm ischaemia time (WIT), estimated blood loss (EBL), complications using the Clavien-Dindo (CD) grading system and oncological outcomes including positive surgical margin (PSM) rates. Patients in group 1 (n=50) and group 2 (n=50) had comparable pre-operative RENAL scores, ASA scores and tumour size characteristics. Ninety-four percent of the patients in group 1 underwent retroperitoneal LPN while 96% of patients in group 2 underwent transperitoneal RALP. The mean total operative time in groups 1 and 2 was 163 versus 195min, respectively (p=0.003), and EBL was 294 versus 187ml (p<0.001). There was no statistically significant difference in WIT between groups 1 and 2 (24.7 and 21.8min, respectively, p=0.18). Post-operative histology was comparable in the two groups and the PSM rate was 8 versus 4% (p=0.58). The CD major complication rate was 16% in group 1 versus 4% in group 2 (p<0.001). In our series, RALPN appears to have a longer initial total operative time than LPN; however, this reduces after the first 20 cases. RALP has a significant reduction in EBL and post-operative major complication rates, including immediate peri-operative complication rates such as the risk of acute haemorrhage or urinoma. Our data indicates that it is safe to change from LPN to RALPN with no compromise in patient safety or oncological outcomes.