Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores

Area of Science:

• Urology
• Robotic Surgery
• Nephrology

Background:

• Robot-assisted partial nephrectomy (RPN) is a minimally invasive technique for kidney tumor removal.
• Transperitoneal (TP) and retroperitoneal (RP) approaches are common access routes for RPN.
• Comparative analysis of perioperative outcomes between TP and RP RPN is crucial for surgical decision-making.

Purpose of the Study:

• To compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (RP) robot-assisted partial nephrectomy (RPN).
• To conduct a matched analysis using nephrometry systems to evaluate surgical results.
• To assess the viability of RP RPN as a treatment option for renal masses.

Main Methods:

• Retrospective analysis of 107 patients undergoing RPN by a single surgeon.
• Comparison of 57 patients in the TP RPN group and 50 patients in the RP RPN group.
• Matched-pair analysis using RENAL score and C-index to compare perioperative outcomes and renal function changes.

Main Results:

• No significant differences in patient demographics, tumor characteristics, or RENAL/ASA scores between TP and RP RPN.
• RP RPN demonstrated shorter median operation times (120 min vs. 150 min) and mean warm ischemic times (22.6 min vs. 26.2 min) compared to TP RPN.
• Estimated blood loss, pain scores, and postoperative complication rates (Clavien class I/II) were similar between the two groups.

Conclusions:

• Retroperitoneal robot-assisted partial nephrectomy (RP-RPN) offers a shorter operative time compared to transperitoneal RPN (TP-RPN).
• Perioperative outcomes, including blood loss, pain, and complications, are generally equivalent between RP-RPN and TP-RPN.
• RP-RPN is a feasible and effective surgical approach for posterior or lateral renal masses.