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. 2021 Jul;47(4):305-312.
doi: 10.5152/tud.2021.21008.

Robot-assisted partial nephrectomy: A single-center matched-pair analysis of the retroperitoneal versus the transperitoneal approach

Ahmed Eraky  1 , Claudius Hamann  1 , Nina N Harke  2 , Marina Tropmann-Frick  3 , Klaus-Peter Jünemann  1 , Daniar Osmonov  1
Affiliations

Robot-assisted partial nephrectomy: A single-center matched-pair analysis of the retroperitoneal versus the transperitoneal approach

Ahmed Eraky et al. Turk J Urol. 2021 Jul.

Abstract

Objective: Comparison of the retroperitoneal (RRPN) perioperative variables and the transperitoneal (TRPN) robot-assisted partial nephrectomy (RPN) using a matched-pair analysis.

Material and methods: A retrospective review was carried out for 224 patients who underwent RPN between 2014 and 2019. A matched-pair analysis was performed on 51 pairs of patients. The matching criteria were age, Charlson comorbidity index, body mass index, the grade of renal insufficiency, tumor diameter, and Preoperative Aspects and Dimensions Used for an Anatomical Classification of Renal Tumors score.

Results: The time to reach the renal hilum (P < .001), the overall complication rate (P ¼ .008), and the major complication rate (P ¼ .01) were lower in the RRPN group. The operative time was 143 vs 150minutes (P ¼ .63) in RRPN vs TRPN, respectively. Warm ischemia time was 10minutes in RRPN vs 12minutes in TRPN (P ¼ .07). Early unclamping was used in 71% in RRPN vs 48% in TRPN (P ¼ .02). The length of hospital stay was 6 days in both groups (P ¼ .11). The cases' complexity, the rate of positive surgical margins, and postoperative kidney function were comparable in both groups (P > .05).

Conclusion: The advantages of RRPN lie in the shorter time to reach the renal hilum and the lower complication rates; the comparability with the other parameters proves the safety and feasibility of the RRPN access for localized kidney tumors.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Schematic imaging for trocar positioning for the retroperitoneal approach. The patient is placed in the lateral decubitus position. The camera trocar is placed 2 cm above the lumbar triangle; the first trocar is inserted 3 cm above and at least 7 cm away from the camera trocar along the posterior axillary line. The second trocar is placed along the anterior axillary line and at least 7 cm away from the camera trocar; the working trocar 3 cm is inserted above the anterior superior iliac spine (image courtesy of Daniar Osmonov, MD).
See this image and copyright information in PMC

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