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

Mittakanti, Harsha R.; Heulitt, Gerald; Li, Hsin-Fang; Porter, James

doi:10.1007/s00345-019-02903-7

Cited by 57 publications

(65 citation statements)

References 13 publications

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“…Because of the characteristics and advantages of RLPN, RLPN is a good surgical approach. If the surgeon has su cient experience and the proper technique is applied, compared to TLPN, the operation time and blood loss of RLPN may be shorter, and the postoperative results and oncologic effects of these techniques are similar 25,26 . Despite advances in robot-assisted surgery, retroperitoneal laparoscopic partial nephrectomy is still the standard and most popular procedure in many areas.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Jin¹,

Wang²,

Yang³

et al. 2020

Preprint

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Background: Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking.Methods: We retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC).Results: A total of 107 patients were ultimately evaluated. The median tumor size was 36.88 mm, and the median WIT, total operation time (OT) and estimated blood loss (EBL) were 18.97 min, 80 min, and 100 ml, respectively. Significant differences in WIT were identified among the complexity groups for each scoring system. Significant differences were identified between the OTs associated with the DAP and RENAL score complexity groups. The scores included in this study were significantly associated with the probability of having a WIT >20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.Conclusions: The scores included in this study were useful for preoperative assessment of retroperitoneal laparoscopic partial nephrectomy. No significant differences were observed among the scores in terms of their ability to predict prolonged hot ischemia time or high-grade postoperative complications. DAP is a good score in the retroperitoneal circumstance when its consistency is taken into account.

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Section: Discussionmentioning

confidence: 99%

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Jin¹,

Wang²,

Yang³

et al. 2020

Preprint

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show abstract

“…No differences were found in terms of operative time, WIT, PSM RATE, intraoperative complications, conversion to RN, postoperative major complications, and change in eGFR (p values >0.05). Mittakanti and colleagues [18] reviewed 281 cases of patients treated by robotic retroperitoneal PN and 263 cases of transperitoneal PN from 2006 to 2016. They conducted a matched paired study on 166 pairs of cases.…”

Section: Transperitoneum Approach Versus Retroperitoneum Approachmentioning

confidence: 99%

“…Ficarra et al [27] developed the PAUA score, which integrates the tumor size and anatomical features of renal mass. In 2010, Simmons et al [28] published the c-index renal tumor scoring system, which re- Shorter operative time [16,17] Lower EBL [16][17][18] A shorter duration of hospital stay [16][17][18] A faster return of bowel function [18] Avoid colonic mobilization; reduce the risk of bowel injury [49] Ensure a more direct access to the kidney and renal hilum Limited land marks [17] Easier to access the renal artery [18] MIPN, minimal invasive partial nephrectomy; EBL, estimate blood loss.…”

Section: Renal Nephrometry Scoring Systemsmentioning

confidence: 99%

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

Cheng

Zhang

et al. 2020

Urol Int

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Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology control as radical nephrectomy; moreover, they can offer better preservation of renal function, thus obtaining longterm living benefits. The indications are also expanding, making it possible for larger and more difficult tumors. Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy can be performed by transperitoneal and retroperitoneal approaches, with their individual advantages and limitations. In addition, the renal tumor scoring systems have been widely used and studied in laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. In order to better preserve renal function, the zero-ischemia technique is widely used. The application of intraoperative imaging technology provides convenience and greater benefits. Besides, whether minimal invasive partial nephrectomy can be performed without stop antiplatelet treatment is still disputed. Clinicians perform substantial exploration and practice to achieve the "trifecta" of surgery: complete resection of the tumor, maximum protection of renal function, and no complications.

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“…Just like laparoscopy, most early RPNs were performed through the transperitoneal approach ( 6 ). The increased space through the abdominal approach allows the arm to be spaced sufficiently to reduce external conflicts.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

et al. 2021

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BackgroundTo compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).MethodsA literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% conﬁdence intervals (CIs) were estimated using ﬁxed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.ResultsEleven studies embracing 2,984 patients were included. There was no signiﬁcant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.ConclusionRRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.

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

Cited by 57 publications

References 13 publications

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

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