Introduction

Several authors have recently reported the feasibility of retroperitoneal robotic partial nephrectomy (RRPN) for excision of renal masses. However, very few study comprised an appropriate control group of transperitoneal robotic partial nephrectomy (TRPN). In this study, our main objective was to compare perioperative outcomes of TRPN and RRPN.

Methods

All patients who underwent RRPN in 4 departments of urology between 2010 and 2014 were included in the study. In 3 of these institutions, the retroperitoneal route was chosen mainly for posterior tumors and when it seemed technically feasible (large and complex posterior tumors were resected via a transperitoneal robotic approach). In the last institution, all renal tumors (either anterior or posterior) were resected through a transperitoneal robotic approach. RRPN were matched to TRPN in a 1 to 1 fashion according to the following variables : RENAL NEPHROMETRY Score ; anterior or posterior location of the tumor ; tumors size and surgeon’s experience (categorized a ? 50 procedures, 20-50 procedures or < 20 procedures). Perioperative data were compared between the TRPN and RRPN groups.

Results

Eighty-six RRPN were included for analysis and matched to 86 TRPN. Eighty-five tumors were posterior in each group (98.8%). Mean RENAL NEPHROMETRY Score was 6.7 and mean tumor size was 2.5 cm in both groups. Operative time (111 vs. 156 min ; p<0.0001) and warm ischemia time (11 vs. 14 min ; p=0.02) were shorter in the RRPN group. Patients in the RRPN group had lower estimated blood loss (116 vs. 386 mL ; p<0.0001) but with no impact on transfusion rates (4% vs. 7% ; p=0.37). Positive surgical margin rates (8% vs. 3.5% ; p=0.2) and major complication (i.e. ? Clavien grade 3) rates (6% vs. 6% ; p=0.89) were similar between both groups. There was a trand toward higher complication rate in the TRPN group (21% vs. 10% ; p=0.06). Length of stay was shorter in the RRPN group (3.5 vs. 5.4 days ; p=0.01).

Conclusions

RRPN, mostly performed for small posterior tumors, is associated with decreased operative time, warm ischemia time, blood loss and length of stay. Further data are needed to confirm its impact on complication rates.

Funding

none