Nobuyuki Hinata1, Ryoichi Shiroki2, Kazunari Tanabe3, Masatoshi Eto4, Atsushi Takenaka5, Mutsushi Kawakita6, Isao Hara7, Fumiya Hongo8, Naokazu Ibuki9, Yasutomo Nasu10, Jun Teishima11, Noriyasu Kawai12, Akihiro Kawauchi13, Tsunenori Kondo14, Naoki Kawamorita15, Chikara Oyama16, Shigeo Horie17, Masaki Shimbo18, Masashi Kato19, Hiroomi Kanayama20, Yuya Koito21, Masato Fujisawa1. 1. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. 2. Department of Urology, Fujita Health University, Toyoake, Japan. 3. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 4. Department of Urology, Kyushu University Graduate School of Medicine, Fukuoka, Japan. 5. Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan. 6. Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan. 7. Department of Urology, Wakayama Medical University, Wakayama, Japan. 8. Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Department of Urology, Osaka Medical College, Takatsuki, Japan. 10. Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. 11. Department of Urology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. 12. Department of Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 13. Department of Urology, Shiga University of Medical Science, Otsu, Japan. 14. Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 15. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. 16. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 17. Department of Urology, Juntendo University, Tokyo, Japan. 18. Department of Urology, St Luke's International Hospital, Tokyo, Japan. 19. Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 20. Department of Urology, Tokushima University Graduate School of Medicine, Tokushima, Japan. 21. Department of Urology, Kansai Medical University, Hirakata, Japan.
Abstract
OBJECTIVE: To investigate whether robot-assisted partial nephrectomy compared with laparoscopic partial nephrectomy is effective for renal hilar tumor removal. METHODS: This was a prospective, multicenter, single-arm, open-label trial with a 2-year enrollment period. A total of 22 academic hospitals in Japan participated in the present study. Comparison with historical control values from reported studies of laparoscopic partial nephrectomy was carried out. The warm ischemia time and positive surgical margin rate were set as primary perioperative and oncological outcomes. In the historical control group, these were 27.7 min and 13%, respectively. RESULTS: The analysis population included 105 participants. The mean warm ischemia time was 20.2 (95% confidence interval 16.7-21.8; P < 0.0001 vs 27.7). Two of 103 participants (1.9%) had a positive surgical margin (95% confidence interval 0.5-6.8%). Both results satisfy the prespecified decision criteria for the superiority of robot-assisted partial nephrectomy over the historical control of laparoscopic partial nephrectomy. Resected weight and preoperative estimated glomerular filtration rate were predictive factors of functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy. CONCLUSION: Robot-assisted partial nephrectomy for clinical T1 renal hilar tumors results in shorter warm ischemia time than and comparable positive surgical margin rate to those reported for laparoscopic partial nephrectomy.
OBJECTIVE: To investigate whether robot-assisted partial nephrectomy compared with laparoscopic partial nephrectomy is effective for renal hilar tumor removal. METHODS: This was a prospective, multicenter, single-arm, open-label trial with a 2-year enrollment period. A total of 22 academic hospitals in Japan participated in the present study. Comparison with historical control values from reported studies of laparoscopic partial nephrectomy was carried out. The warm ischemia time and positive surgical margin rate were set as primary perioperative and oncological outcomes. In the historical control group, these were 27.7 min and 13%, respectively. RESULTS: The analysis population included 105 participants. The mean warm ischemia time was 20.2 (95% confidence interval 16.7-21.8; P < 0.0001 vs 27.7). Two of 103 participants (1.9%) had a positive surgical margin (95% confidence interval 0.5-6.8%). Both results satisfy the prespecified decision criteria for the superiority of robot-assisted partial nephrectomy over the historical control of laparoscopic partial nephrectomy. Resected weight and preoperative estimated glomerular filtration rate were predictive factors of functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy. CONCLUSION: Robot-assisted partial nephrectomy for clinical T1 renal hilar tumors results in shorter warm ischemia time than and comparable positive surgical margin rate to those reported for laparoscopic partial nephrectomy.