Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a)

To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta-analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies.

A systematic review of the literature was performed to identify studies comparing LPN and RPN. Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected. Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected. A meta-analysis using random effect model was performed. A further Bland-Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques.

Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN). There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] -12.01 to 104.26). Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI -15.22 to 3.70). Also, LOS (P = 0.22, 95% CI -0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI -0.05 to 0.06).

Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient. Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.