Nina N Harke1, Christopher Darr2, Jan Philipp Radtke2, Nicola von Ostau2, Frank Schiefelbein3, Ahmed Eraky4, Claudius Hamann4, Tibor Szarvas5, Boris A Hadaschik2, Marina Tropmann-Frick6, Klaus-Peter Juenemann4, Georg Schoen7, Daniar Osmonov4. 1. Department of Urology, University Hospital Essen, Essen, Germany. Electronic address: harke.nina@mh-hannover.de. 2. Department of Urology, University Hospital Essen, Essen, Germany. 3. Department of Urology, Missioklinik, Wuerzburg, Germany. 4. Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany. 5. Department of Urology, University Hospital Essen, Essen, Germany; Department of Urology, Semmelweis University, Budapest, Hungary. 6. Hamburg University of Applied Sciences, Hamburg, Germany. 7. Department of Urology, Missioklinik, Wuerzburg, Germany; Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany.
Abstract
BACKGROUND: With increasing acceptance of robotic partial nephrectomy over the last decade, there is an ongoing discussion about the transperitoneal versus retroperitoneal access. OBJECTIVE: To report outcomes after transperitoneal (TRPN) versus retroperitoneal (RRPN) robotic partial nephrectomy. DESIGN, SETTING, AND PARTICIPANTS: A total of 754 patients were identified from the databases of three high-volume centers who underwent either TRPN (n = 551) or RRPN (n = 203). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Perioperative data were evaluated retrospectively. A propensity score matched-pair analysis was performed with the following variables: grade of renal insufficiency, age, body mass index, tumor diameter, and preoperative aspects and dimensions used for an anatomical (PADUA) score with a subsequent subgroup analysis for tumor location. For quality outcomes, the margin, ischemia, and complications (MIC) criteria were used (negative margins, ischemia time <20 min, and no major complications). Statistical analyses included chi-square and Mann-Whitney U tests. RESULTS AND LIMITATIONS: In all, 176 patients could be matched in each group. The median tumor diameter was 28 mm with a PADUA score of 9. In 11% of RRPN versus 44% of TRPN cases, an anterior tumor location was found, and in 55% versus 30%, a posterior lesion was found (p < 0.001). Operative time (119 vs 139 min, p < 0.001) and warm ischemia time (9 vs 10 min, p = 0.003) were significantly shorter for RRPN. No significant differences were observed between intra- and postoperative complication rates, with 8% major complications in TRPN versus 3% in RRPN (p = 0.06). The MIC criteria were achieved in 90% in the RRPN versus 88% in the TRPN group, without differences for tumor location. CONCLUSIONS: Significant differences between TRPN and RRPN could be found for intraoperative time, while complication rates and quality outcomes were comparable. RRPN can also be a considerable alternative for anterior tumors. PATIENT SUMMARY: In this study, we demonstrate that robotic partial nephrectomy is feasible with either a transperitoneal or a retroperitoneal surgical access. The posterior approach can also be used for anterior renal tumors and may result in shorter operative time.
BACKGROUND: With increasing acceptance of robotic partial nephrectomy over the last decade, there is an ongoing discussion about the transperitoneal versus retroperitoneal access. OBJECTIVE: To report outcomes after transperitoneal (TRPN) versus retroperitoneal (RRPN) robotic partial nephrectomy. DESIGN, SETTING, AND PARTICIPANTS: A total of 754 patients were identified from the databases of three high-volume centers who underwent either TRPN (n = 551) or RRPN (n = 203). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Perioperative data were evaluated retrospectively. A propensity score matched-pair analysis was performed with the following variables: grade of renal insufficiency, age, body mass index, tumor diameter, and preoperative aspects and dimensions used for an anatomical (PADUA) score with a subsequent subgroup analysis for tumor location. For quality outcomes, the margin, ischemia, and complications (MIC) criteria were used (negative margins, ischemia time <20 min, and no major complications). Statistical analyses included chi-square and Mann-Whitney U tests. RESULTS AND LIMITATIONS: In all, 176 patients could be matched in each group. The median tumor diameter was 28 mm with a PADUA score of 9. In 11% of RRPN versus 44% of TRPN cases, an anterior tumor location was found, and in 55% versus 30%, a posterior lesion was found (p < 0.001). Operative time (119 vs 139 min, p < 0.001) and warm ischemia time (9 vs 10 min, p = 0.003) were significantly shorter for RRPN. No significant differences were observed between intra- and postoperative complication rates, with 8% major complications in TRPN versus 3% in RRPN (p = 0.06). The MIC criteria were achieved in 90% in the RRPN versus 88% in the TRPN group, without differences for tumor location. CONCLUSIONS: Significant differences between TRPN and RRPN could be found for intraoperative time, while complication rates and quality outcomes were comparable. RRPN can also be a considerable alternative for anterior tumors. PATIENT SUMMARY: In this study, we demonstrate that robotic partial nephrectomy is feasible with either a transperitoneal or a retroperitoneal surgical access. The posterior approach can also be used for anterior renal tumors and may result in shorter operative time.
Authors: Lukas Rath; Friedrich Jokisch; Gerald Bastian Schulz; Alexander Kretschmer; Alexander Buchner; Christian G Stief; Philipp Weinhold Journal: Res Rep Urol Date: 2021-11-23
Authors: P Sparwasser; S Epple; A Thomas; R Dotzauer; K Boehm; M P Brandt; R Mager; H Borgmann; M M Kamal; M Kurosch; T Höfner; A Haferkamp; I Tsaur Journal: World J Urol Date: 2022-01-17 Impact factor: 3.661