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Hand Assisted vs Robotic Assisted Laparoscopic Partial Nephrectomy; Comparison of short-term outcomes.
Sammy E Elsamra, Andrew Leone, Michael Lasser, Simone Thavaseelan, George Haleblian, Gyan Pareek
Warren Alpert Medical School of Brown University, Providence, RI

Introduction: Robotic assisted laparoscopic partial nephrectomy (RALPN) may offer superior outcomes compared with laparoscopic partial nephrectomy (LPN). However, no previous analysis compared RALPN to hand assisted laparoscopic partial nephrectomy (HALPN). Herein, we compared our experience with RALPN and HALPN.
Materials & Methods: The records of LPN from 2006 to 2010 were reviewed. Patient age, tumor pathology, grade, stage, size of tumor, estimated blood loss (EBL), hospital length of stay (LOS), and change in creatinine were noted. Comparison was performed by Student's t-test.
Results: Of 69 patients, 47 underwent HALPN (2006-2010) and 21 underwent RALPN (2008-2010). Exclusion criteria included concurrent laparoscopic cholecystectomy (n = 4 HALPN) and conversion to open (n = 2 RALPN). Table 1 shows number of cases, mean age, tumor size, operative time, room time, EBL, LOS, change in Cr, proportion clamped, and complications for each group.
Our data reveals that while LOS is significantly shorter for RALPN, operative and room times were significantly shorter for HALPN. There was a non-statistically significant decreased complication rate associated with HALPN, with no conversions to open procedure in the HALPN cohort. Hilar vessel clamping was utilized in the minority of HALPN versus the majority of RALPN. One may consider HALPN for its benefit of decreased technical difficulty, tactile feedback, shorter operative and room times, decreased need for hilar clamping and similar complication rate.

Comparison between HALPN and RALPN
Number of Cases4219
Tumor Size2.5 cm (1.4)2.5 cm (1.2)0.94
Estimated Blood Loss136 ml (151)178 ml (249)0.54
Surgery Time149 min (39)212 min (53)<0.001
Room Time203 min (42)275 min (47)< 0.001
Length of Stay4.2 days (1.4)3.5 days (0.6)0.44
Proportion with Hilar Vessel Clamping1 of 42 (2.38%)17 of 19 (89.47%)z=6.6 **significant**
Change in Cr (last Cr obtained in hospital minus pre-op Cr)0.004-0.0250.44
Copmlication Rate5 of 42 (11.9%)4 of 19 (21%)z=0.54 **not significant**

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