A comparison of robotic, laparoscopic and open partial nephrectomy

Steven M. Lucas, Matthew J. Mellon, Luke Erntsberger, Chandru Sundaram

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Introduction: Comparison of treatments for partial nephrectomy is limited by case selection. We compared robotic (RPN), laparoscopic (LPN), and open partial nephrectomy (OPN), controlling for tumor size, patient age, sex, and nephrometry score. Methods: RPN, LPN, and OPN procedures between March 2003 and March 2010 were reviewed. All RPN and LPN were included, and 2 OPN were matched for each RPN in tumor size (±0.5cm), patient age (±10 y), sex, and nephrometry score. Perioperative outcomes were compared. Results: Ninety-six partial nephrectomy procedures were reviewed: 27 RPN, 15 LPN, and 54 OPN. RPN, LPN, and OPN had similar median tumor size (2.4, 2.2, and 2.3cm, respectively), nephrometry score (6.0 each), and preoperative glomerular filtration rate (71.5, 84.6, and 77.0 mL/min/1.73m2, respectively). Blood loss was higher for OPN (250 mL) than for RPN or LPN (100 mL), P < 0.001. Operative time was shorter in OPN (147 min) than in RPN (190 min) or LPN (195 min), P <.001. Median warm ischemia time was shorter for OPN (12.0 min) than for RPN (25.0 min) or LPN (29.5 min), P Kt;.05. Cold ischemia time for OPN was 25.0 min. A 10% glomerular filtration rate decline occurred in 10 RPN, 5 LPN, and 29 OPN cases (P <.252). Median hospital stay for LPN and RPN was 2.0 d versus 3.0 d for OPN (P <.001). Urine leak occurred in 1 RPN and 3 OPN cases. Postoperative complications occurred in 4 RPN (3 were Clavien grade 2 or less), 1 LPN (grade 1), and 7 OPN (6 were grade 2 or less) cases. Conclusion: Renal function preservation and complications are similar for each treatment modality. OPN offers faster operative and ischemia times at the expense of greater blood loss and hospital stay.

Original languageEnglish
Pages (from-to)581-587
Number of pages7
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Volume16
Issue number4
DOIs
StatePublished - Oct 2012

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Robotics
Nephrectomy
Operative Time
Glomerular Filtration Rate
Length of Stay
Cold Ischemia
Warm Ischemia
Neoplasms

Keywords

  • Laparoscopy
  • Nephrometry score
  • Nephron-sparing surgery
  • Robotics

ASJC Scopus subject areas

  • Surgery

Cite this

A comparison of robotic, laparoscopic and open partial nephrectomy. / Lucas, Steven M.; Mellon, Matthew J.; Erntsberger, Luke; Sundaram, Chandru.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons, Vol. 16, No. 4, 10.2012, p. 581-587.

Research output: Contribution to journalArticle

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AU - Mellon, Matthew J.

AU - Erntsberger, Luke

AU - Sundaram, Chandru

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N2 - Introduction: Comparison of treatments for partial nephrectomy is limited by case selection. We compared robotic (RPN), laparoscopic (LPN), and open partial nephrectomy (OPN), controlling for tumor size, patient age, sex, and nephrometry score. Methods: RPN, LPN, and OPN procedures between March 2003 and March 2010 were reviewed. All RPN and LPN were included, and 2 OPN were matched for each RPN in tumor size (±0.5cm), patient age (±10 y), sex, and nephrometry score. Perioperative outcomes were compared. Results: Ninety-six partial nephrectomy procedures were reviewed: 27 RPN, 15 LPN, and 54 OPN. RPN, LPN, and OPN had similar median tumor size (2.4, 2.2, and 2.3cm, respectively), nephrometry score (6.0 each), and preoperative glomerular filtration rate (71.5, 84.6, and 77.0 mL/min/1.73m2, respectively). Blood loss was higher for OPN (250 mL) than for RPN or LPN (100 mL), P < 0.001. Operative time was shorter in OPN (147 min) than in RPN (190 min) or LPN (195 min), P <.001. Median warm ischemia time was shorter for OPN (12.0 min) than for RPN (25.0 min) or LPN (29.5 min), P Kt;.05. Cold ischemia time for OPN was 25.0 min. A 10% glomerular filtration rate decline occurred in 10 RPN, 5 LPN, and 29 OPN cases (P <.252). Median hospital stay for LPN and RPN was 2.0 d versus 3.0 d for OPN (P <.001). Urine leak occurred in 1 RPN and 3 OPN cases. Postoperative complications occurred in 4 RPN (3 were Clavien grade 2 or less), 1 LPN (grade 1), and 7 OPN (6 were grade 2 or less) cases. Conclusion: Renal function preservation and complications are similar for each treatment modality. OPN offers faster operative and ischemia times at the expense of greater blood loss and hospital stay.

AB - Introduction: Comparison of treatments for partial nephrectomy is limited by case selection. We compared robotic (RPN), laparoscopic (LPN), and open partial nephrectomy (OPN), controlling for tumor size, patient age, sex, and nephrometry score. Methods: RPN, LPN, and OPN procedures between March 2003 and March 2010 were reviewed. All RPN and LPN were included, and 2 OPN were matched for each RPN in tumor size (±0.5cm), patient age (±10 y), sex, and nephrometry score. Perioperative outcomes were compared. Results: Ninety-six partial nephrectomy procedures were reviewed: 27 RPN, 15 LPN, and 54 OPN. RPN, LPN, and OPN had similar median tumor size (2.4, 2.2, and 2.3cm, respectively), nephrometry score (6.0 each), and preoperative glomerular filtration rate (71.5, 84.6, and 77.0 mL/min/1.73m2, respectively). Blood loss was higher for OPN (250 mL) than for RPN or LPN (100 mL), P < 0.001. Operative time was shorter in OPN (147 min) than in RPN (190 min) or LPN (195 min), P <.001. Median warm ischemia time was shorter for OPN (12.0 min) than for RPN (25.0 min) or LPN (29.5 min), P Kt;.05. Cold ischemia time for OPN was 25.0 min. A 10% glomerular filtration rate decline occurred in 10 RPN, 5 LPN, and 29 OPN cases (P <.252). Median hospital stay for LPN and RPN was 2.0 d versus 3.0 d for OPN (P <.001). Urine leak occurred in 1 RPN and 3 OPN cases. Postoperative complications occurred in 4 RPN (3 were Clavien grade 2 or less), 1 LPN (grade 1), and 7 OPN (6 were grade 2 or less) cases. Conclusion: Renal function preservation and complications are similar for each treatment modality. OPN offers faster operative and ischemia times at the expense of greater blood loss and hospital stay.

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KW - Nephrometry score

KW - Nephron-sparing surgery

KW - Robotics

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