Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic nephron-sparing surgery (NSS) for renal tumors can utilize transperitoneal or retroperitoneal approaches.
• Robotic retroperitoneal partial nephrectomy (RPPN) and robotic transperitoneal partial nephrectomy (TPPN) are established surgical techniques.

Purpose of the Study:

• To discuss the operative technique for robotic retroperitoneal partial nephrectomy (RPPN).
• To compare outcomes of RPPN versus transperitoneal partial nephrectomy (TPPN) using a matched-pair analysis.

Main Methods:

• Retrospective review of patients undergoing robotic partial nephrectomy between 2006 and 2016.
• A total of 281 RPPN and 263 TPPN cases were identified.
• Matched-pair analysis was conducted on 166 patient pairs to compare outcomes.

Main Results:

• RPPN demonstrated significantly shorter operative times (p < 0.001) and less estimated blood loss (p < 0.001) compared to TPPN.
• No significant differences were observed in case complexity, warm ischemia time, tumor pathology, positive margin rates, complications, or post-operative kidney function between the two groups (p > 0.05).
• Both RPPN and TPPN are viable options for NSS with comparable oncologic control and functional outcomes.

Conclusions:

• Robotic RPPN and TPPN are effective approaches for NSS, yielding good oncologic and functional results.
• RPPN is associated with reduced operative time and blood loss when appropriately indicated.
• The choice between RPPN and TPPN may depend on surgeon experience and comfort level.