title: Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications.
abstract: OBJECTIVE
  To compare surgical results, morbidity and positive surgical margins rate of patients undergoing robotic partial nephrectomy (RPN) versus open partial nephrectomy (OPN).
  
  
  METHODS
  This is an observational multicenter study promoted by the "Associazione GIovani Laparoscopisti Endoscopisti" (AGILE) no-Profit Foundation, which involved six Italian urologic centers. All clinical, surgical, and pathological variables of patients treated with OPN or RPN for renal tumors were gathered in a prospectively maintained database. Tumor nephrometry was measured with PADUA score, and complications were stratified with modified Clavien system. Differences between RPN and OPN group were assessed with univariate analysis. Perioperative variables independently associated with complications were assessed with multivariate analysis.
  
  
  RESULTS
  A total of 198 and 105 patients were enrolled in OPN and RPN group, respectively. Both had similar demographics, indications to surgery, tumor nephrometry, renal function, WIT (18.7 vs. 18.2 min; p = NS), positive margin rate (5.6 vs. 5.7%; p = NS), intraoperative complications, and postoperative medical complications. Compared to OPN, RPN group was significantly more morbid (p = 0.04), included tumors with smaller size (p = 0.002), had longer operative time (p < 0.001), lower blood loss, surgical postoperative complications (5.7 vs. 21.2%, p < 0.001), Clavien 3-4 surgical complications (1 vs. 9.1%, p = 0.001), and shorter hospitalization. The surgical approach resulted independently correlated with surgical complications on multivariate analysis.
  
  
  CONCLUSIONS
  In the present series, RPN was associated with a significant reduction of blood loss, surgical complications, including the reintervention rate for urinary fistula and postoperative bleeding, and with a shorter hospitalization.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze, Villa Monna Tessa, Viale Pieraccini 18, 50139, Florence, Italy, giannivittori@yahoo.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Vittori
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.forename: Simone
authors.initials: S
authors.lastname: Crivellaro
authors.forename: Donato
authors.initials: D
authors.lastname: Dente
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Santo
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Alberto
authors.initials: A
authors.lastname: Gritti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Masieri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morlacco
authors.forename: Angelo
authors.initials: A
authors.lastname: Porreca
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.forename: Paolo
authors.initials: P
authors.lastname: Parma
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaramella
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012371:Robotics; D016896:Treatment Outcome
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