Robotic versus laparoscopic partial nephrectomy for bilateral synchronous kidney tumors: single-institution comparative analysis

Abstract

Objective: To compare the intraoperative and early postoperative outcomes of robotic partial nephrectomy (RPN) with those of laparoscopic partial nephrectomy (LPN) outcomes in patients with bilateral synchronous renal tumors. RPN is emerging as an attractive minimally invasive nephron-sparing approach for renal tumors.

Methods: Our ongoing institutional review board-approved, prospectively maintained, kidney cancer database was used to identify the study population. The medical records of patients who underwent minimally invasive nephron-sparing surgery at our institution from January 2001 to March 2010 were used. A cohort of 9 patients undergoing bilateral RPN was identified and compared with 17 consecutive patients who underwent sequential bilateral LPN. The demographic, intraoperative, postoperative, and short-term renal functional data were retrospectively compared between the 2 groups.

Results: A total of 18 procedures were performed in the RPN group and 32 in the LPN group. The median warm ischemia time was shorter in the RPN group than in the LPN group (19 vs 37 minutes, respectively; P = .059). The median tumor size was 2.85 and 2.7 cm in the RPN and LPN group, respectively (P = .03). The final median postoperative glomerular filtration rate was 68.7 mL/min/1.73 m(2) (interquartile range 14-73) and 26.9 mL/min/1.73 m(2) (interquartile range 20-70) in the RPN and LPN groups, respectively (P = .004). No difference was found in the complications in the RPN group (n = 2) compared with the LPN group (n = 4).

Conclusion: RPN is a safe and effective minimally invasive nephron-sparing treatment of bilateral synchronous kidney tumors. A trend was seen toward a shorter warm ischemia time and less effects on postoperative renal function compared with the laparoscopic approach.