Robotic-Assisted Laparoscopic and Laparoscopic Partial Nephrectomy; A Comparison of a Single-Surgeon's Experience
Anne M. Suskind, MD1, Ryan C. Jackson, none2, Ilene Staff, none2, Steven J. Shichman, MD2.
1University of Connecticut, Farmington, CT, USA, 2Hartford Hospital, Hartford, CT, USA.
Introduction/Objective: Nephron-sparing surgery is considered to be the gold standard for treatment of small renal tumors. Robotic-assisted laparoscopic partial nephrectomy (RALPN) is a recent addition to the Urologist’s armamentarium for treatment of these tumors. In this study, we compare a single surgeon’s experience with RALPN to standard laparoscopic partial nephrectomy (LPN). To date, our RALPN series represents the largest robotic series reported.
Methods: A single surgeon at our institution performed 75 RALPN’s from October 2007 to March 2009. We compared the results of this procedure with the 75 most recently performed standard laparoscopic procedures done by this surgeon. This laparoscopic data was collected from October 2005 to June 2008. Data from both surgical groups were collected prospectively starting in March of 2007. Categorical and outcome variables were analyzed via Chi Square Test and continuous variables were analyzed with T-test for independent groups.
Results: Statistical analysis showed remarkable consistency between the two groups in terms of patient selection/demographics, intra-operative parameters, pathology, and complications. Of note, estimated blood loss (EBL) was found to be statistically different between the two groups; 357.26 cc (SD 345.177) in the laparoscopic group and 257.13 cc (SD 188.277) in the RALPN group (P=0.044). There were 13 complications in the laparoscopic group and 11 complications in the RALPN group. Major complications include 1 aneurysm in the RALPN group, 2 post-operative bleeds in each group, and 1 urine leak in the RALPN group. 1 laparoscopic case was converted to hand assisted laparoscopic (HAL) and 2 were converted to radical nephrectomies. In the robotic series, 1 case was converted to a standard laparoscopic procedure, and no cases were converted to either HAL or to radical nephrectomy. There was a modest decrease in clamp time and in hospital length of stay with the RALPN group, but neither of these findings was statistically significant.
Conclusions: RALPN proves to be a safe and effective alternative to standard laparoscopic partial nephrectomy. Robotic assistance offers the advantages of added degrees of freedom and 3-Dimentional visualization, translating into greater ease of tumor resection and repair. Additionally, robotic surgery has a shorter learning curve for a complex procedure that requires a high degree of laparoscopic proficiency. Our hybrid technique combines the best of both procedures; allowing for rapid dissection of the kidney with easier tumor excision and repair. With this hybrid approach, we feel that we are better poised to resect larger, more endophytic, and centrally located tumors than with the standard laparoscopic technique. This translates into an exciting new tool that will advance our standard of care for renal tumors.