Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic-assisted laparoscopic partial nephrectomy (RALPN) is a common procedure for kidney tumors.
• The retroperitoneal and transperitoneal approaches are two main surgical routes for RALPN.
• Comparative outcome and cost analyses between these approaches are essential for optimizing patient care.

Purpose of the Study:

• To compare perioperative outcomes and costs of retroperitoneal versus transperitoneal RALPN.
• To assess the impact of surgical approach on operative time, length of stay (LOS), renal function, and cancer control.
• To evaluate healthcare costs using time-driven activity-based costing (TDABC).

Main Methods:

• A bicenter, retrospective study of 355 patients undergoing RALPN between 2009-2016.
• Matched analysis of 78 retroperitoneal and 78 transperitoneal RALPN cases based on RENAL nephrometry score, date, and institution.
• Unadjusted and adjusted analyses using McNemar's Chi-squared, paired t-test, and multivariable regression.
• Cost analysis performed using time-driven activity-based costing (TDABC).

Main Results:

• Patients in both groups were similar in age, sex, BMI, and comorbidity.
• Retroperitoneal RALPN was associated with significantly shorter operative times (167.0 vs 191.1 min) and LOS (1.8 vs 2.7 days).
• Adjusted analyses showed retroperitoneal RALPN had 17.6 min shorter operative time and 76% lower probability of LOS ≥ 2 days.
• No differences were observed in renal function preservation or cancer control.
• Transperitoneal RALPN incurred an additional cost of $2337 when factoring in disposable equipment, operative time, LOS, and personnel.

Conclusions:

• Retroperitoneal RALPN is associated with reduced operative times and LOS for posterior and lateral tumors.
• Both approaches demonstrate similar oncologic and functional outcomes.
• The retroperitoneal approach may translate into lower healthcare costs, warranting further investigation for anterior tumors.