Robot-Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy: Comparison of Outcomes

Abstract

Purpose: We report our initial experience with laparoscopy- and robot-assisted partial nephrectomy (RAPN) operations. Materials and Methods: Between November 2003 and April 2009, laparoscopic partial nephrectomy (LPN) was performed in 20 patients (hand-assisted procedure in one patient) and RAPN in 11 patients. Transperitoneal approach was used in both groups. Results: The patient demographics were similar in both groups. The groups were statistically comparable for body mass index (BMI), gender, and American Society of Auesthesiologists (ASA) scores. The mean tumor size was 32.1mm (range 20-41mm) in the RAPN group and 31.45mm (range 15-70mm) in the LPN group. The operative time was 226 minutes (range 120-420) in the LPN group and 185 minutes (range 120-270) in the RAPN group; the difference was not statistically significant (p=0.07). The mean warm ischemia time was significantly shorter in the RAPN group (27.3 minutes for the RAPN group and 35.8 for the LPN group) (p=0.02). The mean estimated blood loss was 286.4mL in the RAPN group and 387.5mL in the LPN group (p=0.3). One patient (5%) had focal positive margin in the LPN group. No patient had positive surgical margins in the RAPN group. Conclusions: In this pilot study, we found that RAPN and LPN are feasible and safe operations in T1 renal tumors. The advantages for RAPN are excision of the tumor under three-dimensional vision and easy suturing with the articulated instruments of the robotic system. The cost and the need for two experienced laparoscopic surgeons are the disadvantages of robotic surgery. Larger randomized studies are needed to evaluate whether RAPN has any advantages over LPN.