title: Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney: a single institution comparative analysis.
abstract: OBJECTIVE
  To compare the outcomes of robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy for renal tumor in patients with a solitary kidney.
  
  
  METHODS
  We retrospectively reviewed data of patients with solitary kidney who underwent laparoscopic (n = 52) and robot-assisted (n = 15) partial nephrectomy for renal tumor at Cleveland Clinic, Cleveland, Ohio, USA, between June 2000 and April 2012. Patient demographic data, perioperative parameters and follow-up data were compared.
  
  
  RESULTS
  The two groups were similar in terms of patients and tumor characteristics, including preoperative renal function and etiology of solitary kidney. The median operative time (225 vs 171 min, P = 0.02), warm ischemia time (19 vs 15 min, P = 0.04) and hospital stay (4 vs 3 days, P = 0.03) were significantly shorter in the robotic group. No significant differences were found in terms of estimated blood loss, transfusion, complications, pathological results and margin status. The median percentage change of renal function was not significantly different between two groups. Long-term hemodialysis was required for three patients in the laparoscopic group (6%) and none of the patients in the robotic group. Median follow up was 15.6 and 5.9 months in the laparoscopic and robotic group, respectively.
  
  
  CONCLUSIONS
  Robot-assisted partial nephrectomy represents a safe and effective minimally-invasive treatment option for renal masses in patients with a solitary kidney. Early comparative outcomes suggest that it offers a significant benefit over the laparoscopic approach in terms of operative time, warm ischemia time and hospital stay. Further studies with a longer follow up are required to confirm the likelihood of better long-term functional and oncological outcomes.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Kamol
authors.initials: K
authors.lastname: Panumatrassamee
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Shahab
authors.initials: S
authors.lastname: Hillyer
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kassab
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics