Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Comparison of laparoscopic versus robotic assisted partial nephrectomy: one surgeon’s initial experience

Jessica M. DeLong¹, Oleg Shapiro², Alireza Moinzadeh¹

1 Institute of Urology, Lahey Clinic, Burlington, Massachusetts, USA
2 Department of Urology, State University of New York, Upstate Medical University, Syracuse, New York, USA
Address correspondence to Dr. Alireza Moinzadeh, Institute of Urology, Urologic Oncology, Lahey Clinic, 41 Mall Road, Burlington, MA01805 USA

Canadian Journal of Urology 2010, 17(3), 5207-5212.

Abstract

Introduction/objective: Partial nephrectomy is an effective surgical treatment for small renal masses. We compare a single surgeon’s experience with consecutive laparoscopic and robotic partial nephrectomy to assess potential perioperative outcomes. A review of the literature is provided.
Materials and methods: A retrospective review was performed comparing 15 consecutive patients undergoing laparoscopic partial nephrectomy to the subsequent consecutive 13 patients undergoing robotic assisted partial nephrectomy for small renal tumors. All patients had normal contralateral kidney appearance on cross sectional imaging. A similar transperitoneal technique was employed for both cohorts. A 4-arm technique was used for the robotic cases using the da Vinci (Intuitive Surgical, Sunnyvale, USA) surgical system. Patient demographics, tumor characteristics, intraoperative, and postoperative data including tumor size, warm ischemia time, and estimated blood loss (EBL) were compared using Student t-test, Wilcoxon rank-sum, or Chi square test as appropriate.
Results: All cases were completed laparoscopically or with robotic assistance without conversion to open surgery. Demographic data were not statistically different between the two groups. Warm ischemia time (WIT) was shorter in the robotic group: 29.7 minutes versus 39.9 minutes for the laparoscopic group (p < 0.0001). Operative time was longer in the robotic group: 253 versus 352 minutes (p < 0.0001). Mean hospital stay and postoperative complication rates were not statistically different. Two (13%) of patients in the laparoscopic group required conversion of partial nephrectomy to radical nephrectomy while none did in the robotic group. Final pathology revealed negative margins in all cases.
Conclusions: Robotic partial nephrectomy resulted in decreased WIT as compared to the conventional laparoscopic approach. Total operative time was increased in the robotic group.

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