Robotic-assisted laparoscopic partial nephrectomy:A comparison of approaches to the posterior renal mass

摘要

AIM:To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.METHODS:Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy(RALPN)for a posterior renal tumor between 2009-2015.Patient demographic characteristics,operative factors,pathology,oncologic outcomes,renal function,and tumor complexity were obtained.Radius of the tumor,exophytic/endophytic properties of the tumor,nearness of tumor to the collecting system,anterior/posterior position,location relative to the polar line(RENAL)nephrometry scores were calculated.nephrometry scores were calculated.The operative approach was determined by the primary surgeon.RESULTS:A total of 91 patients were identified who underwent RALPN for a posterior renal tumor.Fifty-four procedures were performed via the retroperitoneal(RP)approach,and 37 via the transperitoneal(TP)approach.There were no significant differences in patient factors(race,sex,age and body mass index),RENAL nephrometry scores,tumor size,conversion rates,or margin status.Among procedures performed on-clamp,there was no significant difference in warm ischemia times.Total operative time(180.7 min for RP vs 227.8 min for TP,P<0.001),robotic console time(126.9 min for RP vs 164.3 min for TP,P<0.001),and median estimated blood loss(32.5 mL for RP vs 150 mL for TP,P<0.001)were significantly lower via the RP approach.Off-clamp RALPN was performed for 31(57.4%)of RP procedures vs 9(24.3%)of TP procedures.Oncologic and renal functional outcomes were equivalent.CONCLUSION:The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.