Laparoscopic versus robotic assisted partial nephrectomy: one fellowship-trained surgeon’s experience
Jessica DeLong, MD1, Oleg Shapiro, MD2, Ali Moinzadeh, MD1.
1The Lahey Clinic, Burlington, MA, USA, 2State University Of New York, Syracuse, NY, USA.
BACKGROUND: Partial nephrectomy is a standard for the surgical treatment of small renal masses. We compare a single surgeon’s experience with consecutive laparoscopic and robotic partial nephrectomy to assess any potential advantages of one technique over other.
METHODS: Twenty-six patients underwent laparoscopic (n=15) or robotic assisted partial nephrectomy (n=11) for small, asymptomatic renal tumors. All patients had a normal contralateral kidney. A similar transperitoneal technique was employed for both cohorts. After hilar control, the tumor was excised and suture repair performed with Flo-seal and in most cases Surgicel bolster. A 4-arm technique was used for the robotic cases using the da-Vinci surgical system. Patient demographics, tumor characteristics, intraoperative and postoperative data including tumor size, warm ischemia time, estimated blood loss (EBL) and margin rates were compared.
RESULTS: All cases were completed laparoscopically or robotically without conversion to open surgery. Student t test or Wilcoxon rank-sum were used to compare data between the groups. Demographic data including age, Body mass index (BMI), tumor size and EBL were not statistically significantly different. Warm ischemia time was shorter in the robotic group: 29.9 minutes versus 39.9 minutes in the laparoscopic group. Operative time was longer in the robotic group: 352 versus 253 minutes. Mean hospital stay and postoperative complication rates were similar between groups. Two patients in the laparoscopic group required conversion of partial nephrectomy to radical nephrectomy. Final pathology revealed negative margins in all cases.
CONCLUSIONS: Robotic partial nephrectomy resulted in decreased warm ischemia time as compared to the conventional laparoscopic approach. Total operating time was, however, increased in the robotic group.
|Patient age (years)||53.6||58.5||0.299|
|Tumor size (cm)||2.8 (1.4-3.5)||2.6 (1.9-3.8)||0.594|
|EBL (mL-median)||150 (50-1500)||100 (50-300)||0.628|
|Warm ischemia time (minutes)||39.9||29.9||0.003|
|Operative time (minutes)||253||352||0.00004|