Re: Comparative analysis of minimally invasive partial nephrectomy techniques in the treatment of localized renal tumors

摘要

Objective: To report our initial experience with robot-assisted laparoscopic partial nephrectomy compared with traditional laparoscopic partial nephrectomy. Methods: A retrospective review of the Johns Hopkins minimally invasive urologic surgery database identified 207 consecutive patients who had undergone laparoscopic or robotic-assisted laparoscopic partial nephrectomy from 2007 to 2011 by a single surgeon. The patient demographics and pathologic, operative, and perioperative outcomes were compared between the surgical techniques. The early oncologic outcomes are reported for the entire cohort. Results: A total of 102 and 105 patients underwent laparoscopic partial nephrectomy and robotic-assisted laparoscopic partial nephrectomy, respectively. The demographic data were comparable between the 2 groups. The clinical and pathologic tumor characteristics were similar between the 2 groups, and a significant proportion (>=48%) of patients in each group had moderate to high complexity tumors. Patients undergoing robotic-assisted laparoscopic partial nephrectomy had decreased warm ischemia times, estimated blood loss, and operative times on univariate and multi-variate analysis. No difference was seen in the total perioperative or significant urologic complications between the 2 groups. A review of the early oncologic outcomes revealed no local recurrences and 1 case of metastatic renal cell carcinoma. Conclusion: Minimally invasive partial nephrectomy is associated with favorable perioperative outcomes and low morbidity. Robotic-assisted laparoscopic partial nephrectomy appears to be associated with favorable warm ischemia times compared with laparoscopic partial nephrectomy.