Comparison of postoperative recovery after robot‐assisted partial nephrectomy of T1 renal tumors through retroperitoneal or transperitoneal approach: A Japanese single institutional analysis

Abstract

Objective To evaluate the quality of recovery in patients who underwent robot‐assisted partial nephrectomy and to compare the outcomes of the transperitoneal or retroperitoneal approach. Methods This study included 121 patients who underwent robot‐assisted partial nephrectomy under general anesthesia from April 2019 to September 2019 at Tokyo Women’s Medical University, Tokyo, Japan. Quality of recovery was defined according to the QoR‐40 Japanese version. The participants responded to the QoR‐40 Japanese version on three designated days. The patients were assigned to two groups according to the surgical approach: transperitoneal or retroperitoneal. A multivariate logistic regression analysis was carried out to identify independent factors associated with better quality of recovery. Results Out of the 121 patients, 56 (46%) and 65 (54%) patients were included in the transperitoneal and retroperitoneal group, respectively. Although the QoR‐40 Japanese version scores were not different between the two groups at admission, a better quality of recovery was observed in the retroperitoneal group than in the transperitoneal group at discharge based on the total score: physical comfort, emotional state, physical independence and pain. A multivariate analysis showed that the retroperitoneal approach and male sex were associated with a better QoR‐40 Japanese version score at discharge. Conclusions A retroperitoneal approach offers better quality of recovery than a transperitoneal approach, and therefore it might represent the optimal approach in selected patients undergoing robot‐assisted partial nephrectomy.

Retroperitoneal or transperitoneal approach in robot‐assisted partial nephrectomy, which one is better?

“…Finally, we identified 1323 articles after the initial database search. After screening, 21 studies 4‐18 including 5905 patients (TP‐RAPN: 2482 patients; RP‐RAPN: 3423 patients) were eligible for the analysis. All included studies were retrospective studies and were published between 2013 and 2021.…”

“…Overall complication rate data were extracted from 18 studies 13‐17,23‐26 . There are 4499 patients in total with 1692 RP‐RAPN patients and 2807 TP‐RAPN patients.…”

“…The disagreement was resolved by discussion until consensus was reached. Twenty‐one studies 4‐18 published from 2013 to 2021 were included in the meta‐analysis. The following data were pooled from eligible studies: first author, publication date, study type, surgical procedure, number of patients, age, body mass index, tumor size, follow‐up time, and outcome measures (including OT, EBL, WIT, PLOS, overall complications, and major complications).…”

Diagnostic Value of Color Doppler Ultrasound Combined with Superb Microvascular Imaging in the Detection of Small Renal Tumors Less than 3 cm Treated with Jinkui Shenqi Pills

“…Evidence-Based Complementary and Alternative Medicine flap artery in patients with diabetes, which is consistent with the conclusion and proves the scientificity of results in this study. At present, many scholars have affirmed the application value of color Doppler ultrasound in the diagnosis of small renal tumors in their research reports, but some clinical trials have revealed that the detection rate and accuracy of single color Doppler ultrasound for small renal tumors are not high, and its application effect remains unsatisfactory [21,22]. SMI is an imaging test that mainly targets at blood flow velocity in microvessels as well as blood flow classification.…”

Higher risk of intraoperative bleeding in right‐sided renal tumors compared to left‐sided tumors in robot‐assisted partial nephrectomy

“…Furthermore, the indication for PN includes large and complicated tumors if there is technical feasibility for the surgeon according to the National Comprehensive Cancer Network guideline 5,6 . Following the widespread use of the Da Vinci surgical system and the universal health insurance coverage of robot‐assisted PN (RAPN), the number of renal masses treated by RAPN is increasing in Japan 7 …”