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

Wetterlin, Jessica; Blackwell, Robert H.; Capodice, Sarah; Kliethermes, Stephanie; Quek, Marcus L.; Gupta, Gopal N.

doi:10.5410/wjcu.v5.i1.60

Cited by 2 publications

(4 citation statements)

References 16 publications

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“…Similar to others, our data shows that the RP approach is associated with less EBL than its TP counterpart 7 , 10 , 11 , 14 – 17 This was borne out in a recent meta-analysis, although other individual studies have found similar EBL between the two approaches. 9 , 18 , 19 …”

Section: Discussionsupporting

confidence: 90%

“…Similar to others, our data shows that the RP approach is associated with less EBL than its TP counterpart 7,10,11,[14][15][16][17] This was borne out in a recent meta-analysis, although other individual studies have found similar EBL between the two approaches. 9,18,19 A 2020 paper investigating the use of the TP and RP approaches in the treatment of 566 patients from a single surgeon showed that the two groups of patients had similar Pentafecta (i.e., negative surgical margins, no postoperative complications, warm ischemia time ≤ 25 minutes, over 90% eGFR preservation, and no chronic kidney disease progression 1 year after surgery) achievement rates.…”

Section: Discussionsupporting

confidence: 88%

“…Shorter operative times for the RP approach are one of the more common bene ts touted by other studies in the literature; however, there is heterogeneity in this trend. 7,11,[13][14][15] Surprisingly, patients with a history of prior intra-abdominal surgery were signi cantly more likely to have surgery via the TP approach as opposed to the RP approach within our dataset (58.4% vs. 36.8%). While there was a statistically signi cant shorter warm ischemia time for the RP cases compared to the TP ones (12 vs. 21 min), that nding is less likely clinically signi cant.…”

Section: Discussionmentioning

confidence: 81%

“…4,5 Historically, the RP approach has been utilized principally to address posterolateral lesions as it has a fairly direct line of sight on these surfaces of the kidney. [6][7][8][9] However, the scope of the RP approach has gradually expanded to include the extirpation of masses in other regions of the kidney. Takagi et al compared TP and RP approaches when treating lateral tumors while Gu and colleagues investigated the same in the upper pole with ndings in both studies showing lower estimated blood loss (EBL) and a shorter length of stay (LOS) in RP approach patients and similar complication rates between RP and TP approaches.…”

Section: Introductionmentioning

confidence: 99%

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Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Lanzotti,

Felice,

Janakiraman

et al. 2024

J Robotic Surg

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Introduction Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Methods Patients ≥18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008–2022). Baseline demographics, tumor characteristics, and peri-operative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson’s chi-squared test were used to compare continuous and categorical variables, respectively. Results 216 patients were included – 178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size,_and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203 min, p<0.001) and warm ischemia time (12 vs 21 min, p<0.001), and less blood loss (20 vs 100 cc, p=0.002) ( Table 1 ). The RP approach was associated with shorter length of stay (1 vs 2 days, p<0.001) and less total complications (5.3% vs 19.1%, p=0.038). Major complication (Clavien-Dindo Grade ≥3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Conclusions Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Lanzotti,

Felice,

Janakiraman

et al. 2024

J Robotic Surg

View full text Add to dashboard Cite

show abstract

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Lanzotti,

Felice,

Janakiraman

et al. 2023

Preprint

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Introduction Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Methods Patients ≥18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008-2022). Baseline demographics, tumor characteristics, and peri-operative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson’s chi-squared test were used to compare continuous and categorical variables, respectively. Results 216 patients were included – 178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size, and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203 min, p<0.001) and warm ischemia time (12 vs 21 min, p<0.001), and less blood loss (20 vs 100 cc, p=0.002) (Table 1). The RP approach was associated with shorter length of stay (1 vs 2 days, p<0.001) and less total complications (5.3% vs 19.1%, p=0.038). Major complication (Clavien-Dindo Grade >3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Conclusions Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates.

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

Cited by 2 publications

References 16 publications

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery

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