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Comparison of Surgical Outcomes for Laparoscopic versus Robotic Partial Nephrectomy in 200 patients: A Single Surgeon Experience
Kyle T. Finnegan, BS1, Anoop M. Meraney, MD1, Lei Wang, MD2, Stuart S. Kesler, MD1, Steven J. Shichman, MD1.
1Hartford Hospital, Hartford, CT, USA, 2Qilu Hospital of Shandong University, Jinan, China.

Background: Robot-assisted laparoscopic partial nephrectomy (RALPN) is an emerging technique in the treatment of renal tumors. The added benefits of robotic surgery include a 3-demensional field of view and greater degrees of freedom permitting more facile resection of tumor and rapid repair of the renal defect. In this study, we evaluate the perioperative outcomes using a RALPN technique compared to a standard laparoscopic partial nephrectomy (LPN) from a single surgeon’s experience.

Methods: 100 patients underwent LPN from July 2003 - June 2009, and 100 patients underwent RALPN from October 2007 - August 2009 by a single surgeon. Venous and arterial occlusion was performed in every case using laparoscopic bull dog clamps. All tumors were resected, immediately retrieved and sent for frozen section analysis (FSA) to confirm negative margins as renorhaphy was being performed. Perioperative data, pathology, and follow-up patient information were prospectively collected into an IRB-approved database.

Results: In this series, 102 tumors were removed in the LPN group and 103 tumors were removed in the RALPN group. Comparing RALPN to LPN, the warm ischemia time was significantly shorter, 29.4 vs. 33.8 min (p = 0.003), and the complication rate was lower, 15% vs. 20% (15 vs. 20 patients). There were no significant differences in tumor size, (2.6 vs. 2.5 cm) operative time, (193.5 vs. 201.7 min) estimated blood loss, (325.9 vs. 328.3 mL) and length of hospital stay (3.4 vs. 3.2 days) for the LPN vs. RALPN group. 82 vs. 85 (80.4% vs. 82.5%) tumors were of malignant nature in LPN vs. RALPN. There was 1 positive margin in the LPN group vs. 2 positive margins in the RALPN group, which was not statistically significant. Follow up ranges from 2 vs. 2 weeks to 62 vs. 50 months for LPN vs. RALPN, with no local recurrences in either group. 1 patient in the LPN group developed metastatic disease.

Conclusions: Resection of small renal masses utilizing a robotic technique allows better perioperative results to be obtained than by using a standard laparoscopic approach. The 3-dimensional visualization and added degrees of freedom allows for easier and more precise tumor excision and renal reconstruction when using the RALPN technique. Robotic technology improves surgical precision and accuracy and robotics is currently at the forefront of minimally invasive radical prostate surgery. The data shows shorter ischemic times, fewer complications, and no recurrences or metastatic disease for the RALPN group. Randomized prospective studies are needed to further compare LPN to RALPN.

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