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Retroperitoneal Versus Transperitoneal Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis
Jing Fu1, Shan Ye2, Hua-jian Ye1
1Department of Urology, Shaoxing Branch, the First Affiliated Hospital of Zhejiang University School of Medicine (Shaoxing Second Hospital), Shaoxing, Zhejiang 312000, China.
Summary
Retroperitoneal laparoscopic partial nephrectomy (RLPN) is as safe as transperitoneal laparoscopic partial nephrectomy (TLPN) but offers faster operating times and shorter hospital stays. Clinical decisions can be guided by surgeon preference and experience.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrology
Background:
- Partial nephrectomy is a standard treatment for small renal masses.
- Laparoscopic techniques, including retroperitoneal (RLPN) and transperitoneal (TLPN) approaches, are widely used.
- Comparative data on the safety and effectiveness of RLPN versus TLPN are crucial for surgical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze existing literature comparing the safety and effectiveness of RLPN and TLPN.
- To provide evidence-based references for clinicians selecting a laparoscopic partial nephrectomy approach.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Cochrane, EMBASE, MEDLINE, Google Scholar, etc.) for studies published between 2000 and 2015.
- Included studies directly compared RLPN and TLPN.
- Data extraction and quality assessment were performed independently by multiple reviewers, followed by a meta-analysis using Review Manager 5.3.
Main Results:
- Ten studies met the inclusion criteria for the systematic review, with 6 included in the meta-analysis.
- RLPN demonstrated significantly shorter operating times (MD=-33.68 min, P=0.01) and reduced length of hospital stay (MD=-1.47 days, P<0.0001) compared to TLPN.
- No significant differences were observed between RLPN and TLPN regarding tumor size, estimated blood loss, warm ischemia time, positive margin rate, open conversion rate, overall complication rate, or recurrence rate.
Conclusions:
- RLPN appears to be a safe and potentially faster alternative to TLPN for partial nephrectomy.
- The choice between RLPN and TLPN can be based on individual surgical expertise and institutional preferences.
