Cold ischemia technique during robotic partial nephrectomy: a propensity score-matched comparison with open approach

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Open partial nephrectomy (OPN) traditionally uses ice slush for renal cooling.
• Robotic partial nephrectomy (RPN) has successfully reproduced this cold ischemia technique.
• Comparison of outcomes between RPN and OPN with cold ischemia is warranted.

Purpose of the Study:

• To compare perioperative and functional outcomes of RPN versus OPN using cold ischemia.
• To evaluate the efficacy and safety of cold ischemia in robotic partial nephrectomy.

Main Methods:

• A prospectively maintained database (2007-2016) was used to extract patients undergoing PN with cold ischemia.
• Propensity-score (PS) matching (1:2 ratio) was employed to balance baseline characteristics between RPN and OPN cohorts.
• Perioperative (blood loss, complications, hospital stay) and functional (renal function) outcomes were compared.

Main Results:

• Fifty-one RPN and 102 OPN patients were matched for comparison.
• RPN demonstrated significantly less blood loss (100 mL vs. 260 mL), a lower postoperative complication rate (19.6% vs. 37.3%), and shorter hospital stays (3 days vs. 5 days) compared to OPN.
• Renal functional outcomes were comparable between the RPN and OPN groups.

Conclusions:

• The cold ischemia technique is effectively reproducible in robotic partial nephrectomy.
• RPN with cold ischemia offers potential advantages over traditional OPN, including reduced blood loss, fewer complications, and shorter hospital stays.
• Renal function is preserved similarly in both RPN and OPN procedures when employing cold ischemia.