Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Mar 24, 2016; 5(1): 60-65
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.60
Robotic-assisted laparoscopic partial nephrectomy: A comparison of approaches to the posterior renal mass
Jessica J Wetterlin, Robert H Blackwell, Sarah Capodice, Stephanie Kliethermes, Marcus L Quek, Gopal N Gupta
Jessica J Wetterlin, Robert H Blackwell, Marcus L Quek, Gopal N Gupta, Department of Urology, Loyola University Medical Center, Maywood, IL 60153, United States
Sarah Capodice, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
Stephanie Kliethermes, Department of Public Health, Loyola University Medical Center, Maywood, IL 60153, United States
Author contributions: Wetterlin JJ, Blackwell RH, Capodice S, Quek ML and Gupta GN performed the research; Wetterlin JJ, Blackwell RH, Capodice S and Gupta GN wrote the paper; Wetterlin JJ, Gupta GN designed the research study; Kliethermes S contributed analytic tools.
Institutional review board statement: Our project was performed with institutional IRB approval LU#280388 at Loyola University Medical Center.
Informed consent statement: Our study does not involve human subjects research so there was no need for informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jessica J Wetterlin, MD, Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Fahey Center, Room 261, Maywood, IL 60153, United States. jwetterlin@lumc.edu
Telephone: +1-708-2165100 Fax: +1-708-2161699
Received: September 10, 2015
Peer-review started: September 10, 2015
First decision: October 27, 2015
Revised: February 10, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: March 24, 2016
Abstract

AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach.

METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy (RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line (RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon.

RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal (RP) approach, and 37 via the transperitoneal (TP) approach. There were no significant differences in patient factors (race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, there was no significant difference in warm ischemia times. Total operative time (180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time (126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss (32.5 mL for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31 (57.4%) of RP procedures vs 9 (24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent.

CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.

Keywords: Retroperitoneal, Transperitoneal, Robotic-assisted laparoscopic partial nephrectomy, Posterior renal masses

Core tip: A retrospective review was completed to evaluate perioperative outcomes of robotic-assisted laparoscopic partial nephrectomy (RALPN) performed for posterior renal tumors performed via a transperitoneal or retroperitoneal (RP) approach. Ninety-one patients underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the RP approach. Total operative time, robotic console time, and median estimated blood loss were significantly lower via the RP approach. Fifty-seven percent of RP procedures were performed off-clamp. The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to perform the procedure off-clamp.