A comparison of surgical and functional outcomes of robot-assisted versus pure laparoscopic partial nephrectomy.
OBJECTIVE
Robot-assisted partial nephrectomy (RAPN) is emerging as an alternative to laparoscopic partial nephrectomy (LPN) for the treatment of small renal tumors. We compare the results of LPN and RAPN performed by a single surgeon.


METHODS
Data from 100 consecutive patients who underwent LPN (n=52) or RAPN (n=48) performed by a single experienced laparoscopic surgeon between October 2007 and June 2010 were analyzed retrospectively. Perioperative data, including clinical, pathological, and functional outcomes, were compared between the LPN and RAPN groups.


RESULTS
No significant differences were found between groups with regard to mean estimated blood loss, main operation time, warm ischemic time, intraoperative complications, postoperative complications, hospital stay, or percent reduction of hemoglobin. The mean duration of follow-up was 16.2 months for LPN patients versus 8.9 months for RAPN patients (P<.001). With respect to the clamping method, more artery-only clamping occurred during RAPN than LPN (38.5 vs 75%, respectively, P=.001). The mean pathological tumor volume for LPN was 4.0 cm(3) vs 8.2 cm(3) for RAPN (P=.006). The mean resected healthy tissue volume was 25.1 cm(3) for LPN versus 16.1 cm(3) for RAPN (P=.044). There were no significant differences in positive margins or changes in renal function between the 2 cohorts.


CONCLUSIONS
RAPN is a comparable and alternative option to LPN, providing equivalent oncological and functional outcomes, as well as comparable morbidity to LPN. Although RAPN could offer the advantages of saving more healthy marginal tissue, longer-term and larger studies are necessary to evaluate the functional advantages.
Department of Urology, KEPCO Medical Center, Seoul, Republic of Korea.
Jae Duck
JD
Choi
Jong Wook
JW
Park
Hye Won
HW
Lee
Dong-Gi
DG
Lee
Byong Chang
BC
Jeong
Seong Soo
SS
Jeon
Hyun Moo
HM
Lee
Han Yong
HY
Choi
Seong Il
SI
Seo
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D055815:Young Adult