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Retroperitoneal or transperitoneal approach in robot-assisted partial nephrectomy, which one is better?
Jing Zhou1,2, Zheng-Huan Liu1,2, De-Hong Cao1
1Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Cancer Medicine
|May 1, 2021
Summary
The retroperitoneal approach for robot-assisted partial nephrectomy (RP-RAPN) is superior to the transperitoneal approach (TP-RAPN), showing shorter operative times, reduced blood loss, and shorter hospital stays. Both methods demonstrated similar outcomes for surgical margins and complications.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Robot-assisted partial nephrectomy (RAPN) is a standard treatment for kidney tumors.
- The choice between retroperitoneal (RP) and transperitoneal (TP) surgical approaches in RAPN impacts patient outcomes.
- Systematic evaluation of these approaches is crucial for optimizing surgical strategy.
Purpose of the Study:
- To systematically assess and compare the perioperative outcomes of the retroperitoneal (RP) versus transperitoneal (TP) approaches in robot-assisted partial nephrectomy (RAPN).
Main Methods:
- An updated meta-analysis was conducted, including a comprehensive literature search of multiple databases (PubMed, Web of Science, Embase, Cochrane Library, CNKI) up to January 2021.
- Key perioperative outcomes analyzed included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications.
- Data from 21 studies involving 2482 RP-RAPN and 3423 TP-RAPN patients were pooled and analyzed.
Main Results:
- The retroperitoneal approach (RP-RAPN) was associated with significantly shorter operative times (WMD -16.60 min) and postoperative length of stay (WMD -0.46 days) compared to the transperitoneal approach (TP-RAPN).
- RP-RAPN also demonstrated significantly lower estimated blood loss (WMD -21.67 mL).
- No significant differences were observed between the two approaches regarding warm ischemia time, positive surgical margins, or overall/major complications.
Conclusions:
- The retroperitoneal approach is superior to the transperitoneal approach in RAPN concerning operative time, postoperative length of stay, and estimated blood loss.
- Both RP-RAPN and TP-RAPN offer comparable results for surgical margins and perioperative complication rates.
- The findings support the retroperitoneal approach as a potentially advantageous option for select patients undergoing RAPN.
