Login to Access Video or Poster Abstract: MP59-01
Sources of Funding: none

Introduction

The majority of robotic-assisted renal surgery is performed via the transperitoneal route (T). Retroperitoneal robotic-assisted partial nephrectomy (R-RAPN) allows direct access to hilar structures and the posterolateral surface of the kidney. In the few comparative studies published, it has shown potential advantages. We review our institution's experience with RAPN.

Methods

Data from all consecutive patients who underwent RAPN at our single institution between June 2010 and October 2016 were prospectively collected. Demographics, R.E.N.A.L. nephrometry score, and perioperative outcomes were evaluated and comparisons between R-RAPN and T-RAPN were made.

Results

258 patients (119 male, 139 female) underwent RAPN (232 R-RAPN vs 26 T-RAPN). The mean age was 59.7 vs 55.9 (SD±11.9 vs 8.9), mean body mass index was 28.9kg/m2 vs 29.0 (SD±5.5 vs 5.3), and median ASA was 2 (range 1-4 vs 1-3). The mean nephrometry score was 6.1 vs 6.5 (SD±1.7 vs 1.5), tumour size 30.6mm vs 26.8 (SD±12.7 vs 9.8), estimated blood loss 78.9mL vs 116.6 (SD±244.7 vs 178.4), and warm ischaemia time 20.4 minutes vs 20.0 (SD±6.9 vs 6.4). The mean operative time was 130 minutes vs 168 (SD±35.6 vs 32.2) [p<0.05] with a median hospital stay of a single overnight stay vs two. 1.7% patients required blood transfusions in the R-RAPN vs 3.8%. 1.3% cases were converted to robotic-assisted radical nephrectomy in the R-RAPN group vs 3.8% in the T-RAPN group and two cases were converted to open partial nephrectomy in the R-RAPN group. The rate of Clavien III or higher was 1.7% vs 3.8%. There were no renal cancer-related mortalities in this series.

Conclusions

The current series represents the largest single-institution series on R-RAPN, which accounts for 90% of our robotic partial nephrectomy experience. The retroperitoneal route allows direct access to the renal hilum with no requirement for bowel mobilisation. This approach has been shown to decrease operative times, opiate requirement, and allows for quicker return of bowel function. Furthermore, there does not appear to be any increase in perioperative complications using this approach. R-RAPN is an effective alternative to T-RAPN and can be safely and successfully applied to the majority of patients with tumours amenable to nephron preservation.

Funding

none