title: Single surgeon's experience with laparoscopic versus robotic partial nephrectomy:  perioperative outcomes/complications and influence of tumor characteristics on choice of therapy.
abstract: BACKGROUND
  Laparoscopic (LPN) and robotic partial nephrectomy (RPN) may offer similar advantages for nephron-sparing surgery (NSS).  We evaluated the perioperative outcomes and complications of LPN versus RPN and sought to evaluate if one technique may have more favorable outcomes over another based on tumor characteristics.
  
  
  METHODS
  All patients who underwent LPN and RPN by a single surgeon were retrospectively reviewed.  The surgeon almost exclusively performed LPN from February 2009 to January 2011 and RPN from January 2011 to January 2012.  Patient demographics, tumor characteristics, perioperative outcomes, short term renal functional data, and complications were reviewed.  Operative time (OT), warm ischemia time (WIT), and estimated blood loss (EBL) were evaluated for each technique when tumor characteristics were divided by size, location, distance to collecting system, and overall tumor complexity based on nephrometry scoring.
  
  
  RESULTS
  Of 39 laparoscopic cases and 30 robotic cases, there were no significant differences in perioperative outcomes, short term renal functional data, or complications between the two groups except for WIT which was shorter in the LPN group (p = 0.006).  For medium complexity tumors, OT was less for LPN compared to RPN (p = 0.04); for high complexity tumors, EBL was reduced for RPN compared to LPN cases (p = 0.003).  When tumor characteristics were individualized, LPN may be superior to RPN for WIT for small, anterior and exophytic tumors, and tumors located > 5 mm from the collecting system.  LPN and RPN appear more equivocal for WIT in posteriorly located tumors.  Reduced EBL may be a benefit with RPN for larger tumors.
  
  
  CONCLUSIONS
  Although WIT was less in patients undergoing LPN compared to RPN, perioperative outcomes and complications remain similar.  RPN may be beneficial for approaching more difficult, posterior tumors, whereas LPN may be a better technique for WIT for simple, accessible renal tumors.  Reduced EBL may be a benefit for RPN for highly complex tumors.
authors.affiliation: Department of Urology, Boston University Medical Center, Massachusetts, USA.
authors.forename: Nora G
authors.initials: NG
authors.lastname: Lee
authors.forename: Anna
authors.initials: A
authors.lastname: Zampini
authors.forename: Ingolf
authors.initials: I
authors.lastname: Tuerk
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D061646:Operative Time; D059351:Organ Sparing Treatments; D012189:Retrospective Studies; D012371:Robotics; D052096:Warm Ischemia