Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robot-assisted retroperitoneoscopic partial nephrectomy (RARPN) is a viable option for posterior renal masses or patients with prior abdominal surgery.
• Familiarity with RARPN techniques and outcomes is less widespread compared to other minimally invasive approaches.

Purpose of the Study:

• To demonstrate the technique and evaluate the outcomes of Robot-assisted retroperitoneoscopic partial nephrectomy (RARPN).

Main Methods:

• A retrospective multicenter study involving 227 consecutive RARPN procedures was conducted between 2006 and 2013.
• Data collected included operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), length of stay (LOS), complications, positive margins, and cancer recurrence.
• Statistical analyses, including stepwise regression, were used to identify factors associated with outcomes.

Main Results:

• The median patient age was 60 years, with a median BMI of 28.2 kg/m². Median tumor diameter was 2.3 cm.
• Complications occurred in 12.3% of patients, with low rates of urine leaks (1.3%) and pseudoaneurysms (1.3%). Positive margins and recurrence rates were 3.5% and 0.9%, respectively.
• Intersurgeon variation was associated with complications and WIT. Higher surgeon volume correlated with shorter WIT, while higher BMI was linked to longer OT.

Conclusions:

• Robot-assisted retroperitoneoscopic partial nephrectomy (RARPN) demonstrates acceptable morbidity and oncologic outcomes.
• Intersurgeon variation in warm ischemia time and complication rates exists.
• Increased surgeon experience is associated with improved outcomes, specifically shorter WIT.