Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre.
OBJECTIVE
To evaluate the relative merits of robotically assisted partial nephrectomy (RPN), using a matched-pair analysis, with laparoscopic PN (LPN).


METHODS
Between July 2006 and August 2007, 12 patients had RPN for tumour; the outcomes were compared retrospectively with 12 matched patients who had LPN. Patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, tumour side, size and location, and the specific technique used (early vs conventional unclamping). Operative measures evaluated included operative time, estimated blood loss, warm ischaemia time (WIT), and number of ports used. Outcomes measured included serum creatinine and estimated glomerular filtration rate before and after surgery, length of hospital stay, transfusion rate, operative and 30-day complication rate, and surgical margin status.


RESULTS
Overall there were no differences in perioperative variables (WIT, estimated blood loss, surgery time, length of stay) between the groups. Fewer ports were used during LPN. Renal functional outcomes, transfusion rate and complication rates were comparable. Two RPN cases required conversion to standard LPN. A subset analysis of six patients in each group who had early unclamping showed a 7-min shorter WIT with LPN (14 vs 21 min, P = 0.05), despite larger tumours being treated with LPN (3 vs 2.4 cm, P < 0.01) in this subset.


CONCLUSIONS
RPN is a developing procedure, and is technically feasible and safe, albeit with a longer warm WIT than LPN. Further experience is necessary to determine the relative merits of RPN.
Aron
Monish
M
Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. aronm@ccf.org
Koenig
Phillipe
P
Kaouk
Jihad H
JH
Nguyen
Mike M
MM
Desai
Mihir M
MM
Gill
Inderbir S
IS
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D012371:Robotics; D016896:Treatment Outcome; D052096:Warm Ischemia