title: Robotic partial nephrectomy versus laparoscopic partial nephrectomy: a single laparoscopic trained surgeon's experience in the development of a robotic partial nephrectomy program.
abstract: OBJECTIVE
  We evaluated whether the surgical approach during the implementation of a robotic kidney surgery program influenced perioperative and oncologic outcomes.
  
  
  METHODS
  We prospectively evaluated a single institution experience with minimally invasive partial nephrectomy between 2006 and 2010. The study cohort comprised 86 consecutively treated patients who underwent laparoscopic partial nephrectomy (LPN, N = 59) or robotic-assisted (RPN, N = 27) partial nephrectomy by a single surgeon.
  
  
  RESULTS
  There was no difference between the LPN and RPN cohort in terms of gender, age, operative side, American Society of Anesthesiology score, or preoperative estimated glomerular filtration rate (eGFR). An early unclamping technique was used for 22 (82%) patients in the RPN cohort and 6 (10%) patients in the LPN cohort. (P < 0.001). Warm ischemia time was lower in the RPN cohort (mean 18.5 vs. 28.0 min, P = <0.001) as result of majority undergoing early unclamping. There was no difference in operative time, estimated blood loss, length of stay, transfusion rate, positive surgical margin, or postoperative decrease in eGFR. There was no difference in mean eGFR decrease after early unclamping (16%) versus traditional clamping (22%); however, 11 (29%) patients had greater than 50% decrease in eGFR after traditional clamping versus 0 patients after early unclamping (P = 0.014).
  
  
  CONCLUSIONS
  Patients undergoing RPN during implementation of a robotic kidney surgery program when compared with LPN appear to have equivalent perioperative outcomes and oncologic efficacy. RPN patients had surgery later in our minimally invasive partial nephrectomy experience, and these results may not be generalizable to laparoscopic and/or robotic naïve surgeons.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 20015, USA. swilliams22@partners.org
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Williams
authors.forename: Ravi
authors.initials: R
authors.lastname: Kacker
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.forename: Ignacio San
authors.initials: IS
authors.lastname: Francisco
authors.forename: Jodi
authors.initials: J
authors.lastname: Mechaber
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000502:physiology / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D016730:Program Development; D011446:Prospective Studies; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome