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Single Surgeon's Experience with Laparoscopic Versus Robotic Partial Nephrectomy: Perioperative Outcomes and Complications and Influence of Tumor Characteristics On Choice of Therapy
Nora G. Lee, MD1, Anna Zampini, BS, MS2, Ingolf Tuerk, MD, PhD3.
1Boston University Medical Center, Boston, MA, USA, 2Tufts University School of Medicine, Boston, MA, USA, 3Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.

Introduction
Nephron-sparing surgery has become the standard of care of small renal masses with laparoscopic partial nephrectomy (LPN) being a favorable approach over open surgery with comparable long-term outcomes. Robotic partial nephrectomy (RPN) has become a rising technique which may offer similar advantages. We evaluated the perioperative outcomes and complications of LPN versus RPN.
Methods
All patients who underwent LPN and RPN by a single surgeon were retrospectively reviewed from February 2009 to January 2012. The surgeon almost exclusively performed LPN from 2009 to January 2011 and performed RPN from January 2011 to January 2012. Three RPN were performed prior to 2011. Patient demographics, tumor characteristics, perioperative outcomes, short-term renal functional data, and complications were reviewed between the two groups.
Results
See Table 1 for results. There were no significant differences in perioperative outcomes, short-term renal functional data, or complications between the two groups except for warm ischemia time which was less in the LPN group (20.4 minutes vs. 24.9 minutes in the RPN group, p=0.006). Although not significant, RPN trends toward GREATER operative time and reduced estimated blood loss.
Conclusions
Although warm ischemia time may be decreased in patients who undergo LPN compared to RPN, short-term renal functional outcomes remain similar as well as other perioperative outcomes and complications. RPN may be a comparable minimally invasive approach to small renal masses as LPN.
Table 1. Results
LPN (n=39)RPN (n=30)P-value
Patient demographics
Mean age (years)57±1159±110.49
Males/females29/1018/120.21
Caucasian race34 (87%)25 (83%)0.66
Mean BMI (kg/m2)29±530±70.85
Mean ASA score220.99
Tumor characteristics
Mean Size (cm)3.1±1.23.2±1.20.73
Left/right kidney24/1516/140.50
Location
Upper pole13 (33%)6 (20%)0.23
Mid pole20 (51%)15 (50%)0.92
Lower pole6 (15%)9 (30%)0.15
Exophytic3 (8%)4 (13%)0.45
Mesophytic22 (56%)13 (43%)0.29
Endophytic14 (36%)13 (43%)0.54
Mean distance to collecting system (mm)5.0±5.03.9±5.20.41
Pathology
T1a23 (59%)18 (60%)0.93
T1b9 (23%)8 (27%)0.74
T2 or greater4 (10%)1 (3%)0.28
Benign3 (8%)3 (10%)0.74
Histology
Clear cell25 (64%)21 (70%)0.61
Papillary7 (18%)5 (17%)0.83
Chromophobe3 (8%)1 (3%)0.45
Oncocytoma2 (5%)1 (3%)0.72
Neuroectoderm1 (3%)0 (0%)0.38
Other1 (3%)2 (7%)0.41
Fuhrman Grade
1-220 (57%)22 (81%)0.04
3-415 (43%)5 (19%)0.04
Positive margins4 (11%)2 (7%)0.61
Outcomes
Mean estimated blood loss (mL)235±278152±1890.19
Mean warm ischemia time (min)20.4±6.124.9±6.70.006
Mean operative room time (min)119.7±34.1135.5±36.40.08
Mean length of hospital stay (days)2.72.70.99
No. of patients with preoperative eGFR <602 (5%)4 (13%)0.24
No. of patients with postoperative eGFR <6010 (26%)7 (23%)0.83
Average decrease in eGFR10.1±6.57.0±3.30.30
Average decrease in serum creatinine0.4±0.20.2±0.20.09
Complications
Conversion to radical
nephrectomy
2 (5%)0 (0%)0.21
Postoperative urinary leak0 (0%)0 (0%)0.99
Postoperative transfusion2 (5%)1 (3%)0.72
Postoperative embolization due to
hemorrhage
1 (3%)0 (0%)0.38
Postoperative dialysis0 (0%)1 (3%)0.26
Follow-up (months)6.7±10.21.1±1.90.009
± = standard deviation; BMI = body mass index; ASA = American Society of Anesthesiologists; eGFR = estimated glomerular filtration rate


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