Surgical and functional outcomes of robot-assisted versus laparoscopic partial nephrectomy with cortical renorrhaphy omission

Abstract

To evaluate the surgical and functional outcomes between robot-assisted (CRO-RAPN) vs. laparoscopic (CRO-LPN) methods of cortical-renorrhaphy-omitting partial nephrectomy. Between July 2012 and June 2020, patients with localized clinical T1-2 renal masses who underwent CRO-RAPN or CRO-LPN were reviewed. The outcomes of the two groups were compared using propensity-score matching. Trifecta was defined as negative surgical margin, warm ischemic time < 25 min, and absence of complications of Clavien-Dindo grade III or more until three months postoperatively. The preservation rate of the estimated glomerular filtration rate (eGFR) was evaluated at six months postoperatively. Among 291 patients (CRO-RAPN, n = 210; CRO-LPN, n = 81) included in the study, 150 matched pairs of patients were analyzed. Compared to the CRO-LPN group, the CRO-RAPN group was associated with shorter warm ischemic time (13 min vs. 20 min, P < 0.001), shorter total operation time (162 min vs. 212 min, P < 0.001), less estimated blood loss (40 mL vs. 119 mL, P = 0.002), lower incidence of overall complications (3% vs. 16%, P = 0.001), higher preservation rate of eGFR at six months postoperatively (93% vs. 89%, P = 0.003), and higher trifecta achievement rate (84% vs. 64%, P = 0.004). CRO-RAPN contributed to shorter warm ischemic time, less blood loss, fewer complications, and higher preservation of renal function, all of which allowed this technique to achieve a higher rate of trifecta compared to CRO-LPN.

Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

“…In recent years, nephron-sparing surgery, particularly robot-assisted radical nephrectomy (RAPN), has emerged as a widely adopted treatment modality for patients with a renal mass < 7 cm in size, chronic kidney disease, or bilateral renal tumors. It is deemed technically feasible owing to its ability to better preserve renal function [1][2][3][4][5]. Although radical nephrectomy improves oncological outcomes in patients with renal cell carcinoma (RCC), its utility remains controversial as it results in the substantial loss of nephron tissue, potentially contributing to increased morbidity from chronic kidney disease, mortality from cardiovascular disease, and decreased overall survival [6,7].…”

“…(2) single inner-layer renorrhaphy (SILR) with early unclamping [5], (3) double-layer renorrhaphy (DLR) [9], and (4) coagulation of the base following the removal of the renal tumor and sutureless renal parenchyma [1]. Nevertheless, parenchymal reconstruction by renorrhaphy may damage the renal artery branches and affect perirenal blood flow, resulting in irreversible ischemic changes in the remaining normal renal parenchyma [6].…”