Comparison of Perioperative Outcomes Between Robotic and Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis

Choi, Ji Eun; You, Ji Hye; Kim, Dae Keun; Rha, Koon Ho; Lee, Seon Heui

doi:10.1016/j.eururo.2014.12.028

Cited by 346 publications

(256 citation statements)

References 35 publications

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“…More generally, we acknowledge that even for iRPNx for a solitary tumor our reported surgical times are longer than other series in the literature. 19 There are several factors which dictate operative time such as extent of adhesions, complexity of tumors, fellow/resident involvement, disease process, clamping, and other patient specific factors such as previous nonrenal abdominal surgeries and obesity. All these factors might have contributed toward the longer operative times in our cohorts.…”

Section: Discussionmentioning

confidence: 99%

Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes

Watson

Sidana

Diaz

et al. 2016

Journal of Endourology

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Introduction: Multifocal and hereditary kidney cancers often require repeated ipsilateral nephron sparing procedures with higher blood loss and complication rates compared to first time renal surgery. Consequently, many surgeons avoid minimally invasive techniques in the setting. We present the characteristics, complications, and short-term renal functional outcomes of patients who underwent a repeat robotic partial nephrectomy (rRPNx). Materials and Methods: A database was retrospectively reviewed to identify patients who underwent robotic partial nephrectomies between January 2007 and December 2013. Selection criteria for the rRPNx cohort included patients who had undergone at least two ipsilateral renal surgeries, with the second procedure being an rRPNx. All other patients comprised the initial robotic partial nephrectomy (iRPNx) group. Results: One hundred twenty-four patients who underwent robotic partial nephrectomy during the study period were identified. rRPNx constituted 26 (21%) of the total cases. Age of the rRPNx cohort was similar ( p = 0.56), but number of tumors resected was two-fold greater in the rRPNx group ( p = 0.44). Neither surgery time nor renal clamp time was significantly longer in either group ( p = 0.18 and p = 0.65, respectively). Importantly, estimated blood loss (EBL) was significantly larger than in the iRPNx group ( p = 0.01). Both groups had similar intravenous pain medication administration durations ( p = 0.32), but postsurgical length of stay was greater for the rRPNx patients ( p = 0.011). There were no significant differences in clavian complication rates ( p = 0.17-0.39), with the exception of urine leak which occurred more frequently in the rRPNx group ( p = 0.01). There was no difference in percent change in serum creatinine or estimated glomerular filtration rate ( p = 0.89 and p = 0.67, respectively). Conclusions: rRPNx is safe and feasible in select patients. EBL, postoperative lengths of stay, and urine leak were the only factors significantly associated with rRPNx compared to iRPNx. Patient 3-month follow-up revealed excellent and comparable outcomes between the two groups.

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Section: Discussionmentioning

confidence: 99%

Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes

Watson

Sidana

Diaz

et al. 2016

Journal of Endourology

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“…10 Meta-analysis of multiple retrospective studies indicated that LPN and RPN provided comparable hospital stay and complication rates, with an advantage of shorter ischemia time for RPN even with greater tumor complexity in these cases. 9 RPN appears to have extended the reach of LPN, enabling PN to be performed in more complex scenarios and by a greater number of proficient surgeons.…”

mentioning

confidence: 99%

“…3,8 With LPN, and more recently with robotic PN (RPN), ischemia times and complications have decreased substantially. 3,9 When directly comparing similar cohorts undergoing LPN or RPN by the same surgeons, RPN was associated with shorter hospital stays (2.4 vs. 2.7 days), shorter ischemic intervals (19.7 vs. 28.4 min), and lower complication rates (8.6 vs. 10.2 %) in a multi-institutional study. 10 Meta-analysis of multiple retrospective studies indicated that LPN and RPN provided comparable hospital stay and complication rates, with an advantage of shorter ischemia time for RPN even with greater tumor complexity in these cases.…”

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confidence: 99%

Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Bezinque

Lane

2016

Ann Surg Oncol

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Partial nephrectomy (PN) is the reference standard for renal tumors that are amenable to a kidney-sparing approach. With oncologic outcomes superior to thermal ablation and renal functional outcomes superior to radical nephrectomy, the number of situations in which PN is employed is growing.1,2 The outcomes of PN vary greatly with surgeon experience, variations in technique, and tumor complexity. Several techniques have been developed and modified during the past 30 years or more, with contemporary discussions addressing optimization of the oncologic, renal functional, and postoperative outcomes of PN. 3During the late 1990s, minimally invasive PN was pioneered using pure laparoscopic techniques. 4,5 In the initial single-center series reported, laparoscopic PN (LPN) was found to be feasible and with acceptable morbidity when performed by master laparoscopic surgeons who were building upon the experience of prior experts' open surgical techniques. [4][5][6] Comparison of results from these initial series of LPN with OPN performed well after the initial learning curve for this procedure revealed both advantages and disadvantages for LPN despite the somewhat imbalanced comparison.7 LPN offered the advantages of decreased operative time (median 3. In these 1800 patients, the disadvantages of LPN were longer warm ischemia time (median 31 vs. 20 min; RR: 1.69 (95 % CI: 1.62-1.77), p \ 0.0001), more urologic complications (9.2 vs. 5.0 %; odds ratio [OR]: 2.14 (95 % CI: 1.39-3.31), p = 0.0006), and more nonurologic complications (15.7 vs. 14.3 %; OR: 1.53 (95 % CI: 1.12-2.10), p = 0.0077). The major concerns for LPN were the higher observed rate of postoperative hemorrhage and urine leak that was accentuated by the larger tumors and less fit patients in the cohort undergoing OPN. 6 With further refinements in technique, the results of minimally invasive PN have improved substantially during 15? years of refinement. 3,8 With LPN, and more recently with robotic PN (RPN), ischemia times and complications have decreased substantially.3,9 When directly comparing similar cohorts undergoing LPN or RPN by the same surgeons, RPN was associated with shorter hospital stays (2.4 vs. 2.7 days), shorter ischemic intervals (19.7 vs. 28.4 min), and lower complication rates (8.6 vs. 10.2 %) in a multi-institutional study.10 Meta-analysis of multiple retrospective studies indicated that LPN and RPN provided comparable hospital stay and complication rates, with an advantage of shorter ischemia time for RPN even with greater tumor complexity in these cases.9 RPN appears to have extended the reach of LPN, enabling PN to be performed in more complex scenarios and by a greater number of proficient surgeons.The published evidence has suggested that RPN can likely be performed with a favorable risk-benefit profile relative to OPN for well-selected patients. 3,[11][12][13] This present report confirms these prior reports.14 Peyronnet et al. report in this issue of Annals of Surgical Oncology that RPN is associated with favorable perioperat...

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“…[6] While there are many studies comparing LPN and RAPN today, there are unfortunately no randomized studies that compare open PN with RAPN. Choi et al [13] compared 2240 patients who had LPN and RAPN, and reported no significant difference between the two groups with respect to complications, changes in serum creatinine levels, duration of operation, bleeding, and surgical margin positivity. In the same study the authors also reported a lower rate of transition to open surgery and radical nephrectomy, shorter warm ischemia time, shorter hospital stays, and lesser changes in glomerular filtration rates in the RAPN group.…”

Section: Discussionmentioning

confidence: 99%

“…In the same study the authors also reported a lower rate of transition to open surgery and radical nephrectomy, shorter warm ischemia time, shorter hospital stays, and lesser changes in glomerular filtration rates in the RAPN group. [13] In RAPN series by Scoll et al [14] performed on 100 patients, the average size of the excised tumors (2.8 cm), ischemia time (25.5 min), surgical margin positivity rate (5.7%), transition rate to open surgery (2%), major (6%) and minor (5%) complica tion rates were reported as indicated. A retrospective study by Long et al [15] which compared cases with 199 RAPN and 182 LPN did not detect a significant difference across the perioperative parameters but reported a lower rate of transition (1% vs. 11.5% for LPN) to open surgery, and a smaller decrease (12.6% vs. 16%) in the glomerular filtration rate in the RAPN group Abourmarzouk et al [16] conducted a comparative study with 717 patients (313 RAPN vs. 404 LPN) and discovered a shorter warm ischemia time in the RAPN group but did not detect a significant difference with respect to other parameters.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

Özkan

Coşkuner

Yalçın

2016

Turkish Journal of Urology

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Objective: To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. Material and methods:Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. Results:Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p= 0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21 st month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). Conclusion:With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.

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Comparison of Perioperative Outcomes Between Robotic and Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis

Cited by 346 publications

References 35 publications

Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes

Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes

Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

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