Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Robot-assisted partial nephrectomy (RAPN) is a key procedure for kidney tumor treatment.
• Transperitoneal (TP) and retroperitoneal (RP) are two primary surgical approaches for RAPN.
• Comparative data on perioperative outcomes between TP-RAPN and RP-RAPN are crucial for surgical decision-making.

Purpose of the Study:

• To conduct a meta-analysis comparing perioperative outcomes of transperitoneal (TP) versus retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN).

Main Methods:

• A systematic literature search was performed across major databases (MEDLINE, EMBASE, SCOPUS, Cochrane Library) up to March 2016.
• Four studies involving 449 patients (229 TP-RAPN, 220 RP-RAPN) were included for meta-analysis.
• Outcomes analyzed included complication rates, conversion rates, operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and positive surgical margin (PSM).

Main Results:

• No significant differences were observed between TP-RAPN and RP-RAPN in terms of complications, conversion rates, WIT, EBL, or PSM.
• A marginally significant difference in operative time was noted, with RP-RAPN showing a shorter duration (WMD: 28.03 minutes, p=0.05).
• Patient demographics, tumor characteristics (size, laterality, R.E.N.A.L. score), and pathology were comparable between the two groups.

Conclusions:

• The meta-analysis indicates that RP-RAPN is as safe and effective as TP-RAPN regarding complications, conversion, WIT, EBL, and PSM.
• RP-RAPN may offer a slight advantage with a shorter operative time compared to TP-RAPN.
• Further high-quality randomized controlled trials and large observational studies with long-term follow-up are recommended to validate these findings.