Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores.

Abstract

PURPOSE: The purpose of this study was to compare perioperative outcomes of

transperitoneal (TP) and retroperitoneal (RP) robot-assisted partial nephrectomy

(RPN) by matched analysis using nephrometry systems. METHODS: A total of 107

patients who underwent RPN by a single surgeon from December 2008 to June 2012

were analyzed; 57 patients underwent TP RPN and 50 patients underwent RP RPN.

Baseline demographic characteristics, perioperative outcomes and changes in renal

function were collected by retrospective review of medical records. Matched-pair

comparisons were done using RENAL score and C-index. RESULTS: No significant

difference was observed between TP and RP RPN in patient age, body mass index,

gender, laterality, clinical stage, tumor size, RENAL score or ASA score. The TP

RPN had more cystic renal masses (TP vs. RP = 33 vs. 12 %, p = 0.012) and RP RPN

had shorter median operation times (150 vs. 120 min, p = 0.015) and shorter mean

warm ischemic times (26.2 vs. 22.6 min, p = 0.040) than TP RPN. In the

matched-pair analysis, RP RPN showed shorter operation times with similar warm

ischemic times. Estimated blood loss and visual analog pain scales showed no

significant differences between groups. A total of 12 (11.4 %) postoperative

complications occurred, all Clavien class I or II with no significant difference

in incidence. CONCLUSIONS: Retroperitoneal robot-assisted partial nephrectomy

showed shorter operation time and generally equivalent perioperative results to

TP RPN. RP RPN is a viable treatment option for treating posterior or lateral

renal masses.