Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis

Abstract

Purpose

When performing robotic nephron-sparing surgery (NSS) for renal tumors, either a transperitoneal approach or retroperitoneal approach can be utilized. The operative technique for robotic retroperitoneal partial nephrectomy (RPPN) is discussed and a matched-paired analysis comparing both RPPN and transperitoneal partial nephrectomy (TPPN) at a single institution is discussed.

Materials and methods

A retrospective review over a 10-year period (2006–2016) was performed for all patients who underwent robotic partial nephrectomy. A total of 281 patients underwent RPPN and 263 patients underwent TPPN. A matched-paired analysis was performed on 166 pairs of patients and the outcomes reviewed.

Results

Operative time (p < 0.001) and estimated blood loss (p < 0.001) were significantly less in the RPPN group compared to the TPPN group. No differences (p > 0.05) were seen with regard to complexity of cases, warm ischemia time, tumor pathology, positive margin rates, complications, or kidney function post-operatively.

Conclusions

Robotic RPPN and TPPN can both be used for NSS with good results. RPPN, when used appropriately, can lead to shorter operative times, less blood loss and equivalent oncologic and post-operative outcomes. Surgeon comfort and expertise will help determine which approach to use.

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Affiliations

Authors

Contributions

HRM data analysis and manuscript writing/editing. GH project development, data collection/management, and manuscript writing/editing. HFL data analysis. JRP project development, data collection/management, manuscript writing/editing.

Corresponding author

Correspondence to Harsha R. Mittakanti.

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Conflicts of interest

Dr. James Porter: Speaker for Intuitive Surgical, Consultant for Ceevra, C-SATS advisory board. The other authors declare that they have no competing interest.

Research involving human participants

This was a retrospective study on human participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mittakanti, H.R., Heulitt, G., Li, HF. et al. Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis. World J Urol 38, 1093–1099 (2020). https://doi.org/10.1007/s00345-019-02903-7

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Keywords

  • Kidney neoplasms
  • Nephrectomy
  • Retroperitoneal space
  • Minimally invasive surgical procedures
  • Laparoscopy
  • Robotics