A Comparison of Robotic, Laparoscopic and Open Partial Nephrectomy

Lucas, Steven M.; Mellon, Matthew J.; Erntsberger, Luke; Sundaram, Chandru P.

doi:10.4293/108680812x13462882737177

Cited by 71 publications

(70 citation statements)

References 23 publications

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“…3 studies [10], [12], [28] reported the intraoperative renal artery unclamping rate and the pooled data revealed a significantly higher rate in the OPN group than the RPN group (OR: 0.60; 95%CI, 0.38–0.95; p = 0.03) (Fig.2g). …”

Section: Resultsmentioning

confidence: 96%

“…The following studies are cited: Alemozaffar et al 2013 [26], Laydner et al 2013 [27], Lee et al 2011 [10], Lucas et al 2012 [28], Masson-Lecomte et al 2013 [11], Minervini et al 2013 [12], Simhan et al 2012 [13], Yu et al 2012 [29].…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup analysis of postoperative complications, both minor and major complications more frequently occurred following OPN(14.4% versus 19.2%, p = 0.03 and 3.6% versus 8.3%, p = 0.0007, respectively), whereas there was no Clavien grade 5 (death) complication in either group. Lucas et al reported one grade 4a complication in the RPN group (stroke) [28]. In the largest single center non-comparative series to date, which consists of 400 patients undergoing RPN, there were 61 cases (15.3%) of postoperative complications, which were mainly low grade (Clavien grade 3-4 in 3.2%) [30].…”

Section: Discussionmentioning

confidence: 99%

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Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis

Liu

et al. 2014

PLoS ONE

117

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ObjectivesTo critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN).Materials and MethodsA comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.ResultsEight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39–67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42–0.67; p<0.00001), shorter hospital stay (WMD: −2.78; 95%CI, −3.36 to −1.92; p<0.00001), less estimated blood loss(WMD: −106.83; 95%CI, −176.4 to −37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies.ConclusionsRPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis

Liu

et al. 2014

PLoS ONE

117

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“…[38,39] In a study by Marszalek et al [40] , the authors reported relatively decreased warm ischemia times, but comparable amounts of blood loss in laparoscopic technique when compared with OPN. Lucas et al [41] performed a study on 96 patients with SRMs with similar size (2.3 cm), and a nephrometry score of 6, and reported comparable levels of preservability of renal functions, complication rates, and surgical margin positivity for all three methods. In the OPN group, mean operative time (147 min), and duration of warm ischemia (12 min) were reportedly decreased, while authors noted relatively increased blood loss (250 mL), and median hospital stay (3 days).…”

Section: Discussionmentioning

confidence: 99%

The impact of non-hilar clamping open partial technique performed for the treatment of patients with small renal masses with lower R.E.N.A.L. nephrometry scores on renal functions during the early postoperative period

Atılgan

Kılıç

Gençten

et al. 2014

Turkish Journal of Urology

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Objective: Herein, the impact of off-clamp open partial nephrectomy on early postoperative period renal functions were evaluated in patients with low RENAL nephrometry scoring small renal masses. Material and methods:Twenty-three patients (12 women, and 11 men) who had undergone non-hilar clamping open partial nephrectomy in our clinic between the years 2010, and 2013 were retrospectively evaluated. Mean age, body mass index (BMI), operative time, blood loss, renal nephrometry score, mean hospital stay, pre-, and postoperative serum creatinine (Cr), and glomerular filtration rate (GFR) of the patients were assessed. Results:Mean age, BMI, tumor size, and preoperative renal nephrometry scores were 56.09±10.49 years (36-70 yrs), 24.81±2.44 kg/m 2 , 3.68±1.125 cm, and 6.41±1.77 pts, respectively. Mean operative time, intraoperative blood loss, and hospital stay were detected as 139.14±33.60 min, 274.9±77.02 mL, and 4.27±1.12 days, respectively. Preoperative mean serum Cr, and GFR levels were 0.804±0.216 mg/dL, and 93.97±25.83 mL/min/1.73 m 2 , respectively. Postoperative 1. day mean serum Cr, and GFR levels were 0.896±0.25 mg/ dL, and 85.94±28.85 mL/min/1,73 m 2 , while corresponding 3. month-values were 0.81±0.205 mg/dL, and 93.59±21.00 mL/dk/1.73 m 2 , respectively. A statistically significant difference was not found between preoperative, and postoperative 3. month-serum Cr, and GFR levels. However, postoperative 3.month-serum Cr, and GFR levels were lower than corresponding values estimated on postoperative 1. day (p<0.016). Conclusion:One of the important considerations in partial nephrectomy is to preserve renal functions. Therefore, non-hilar clamping open partial nephrectomy should be taken into consideration for surgeons unexperienced especially in laparoscopic surgery with its lower morbidity, and complication rates.

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“…There were no positive surgical margins. The reported rates of positive surgical margins with LPN were 0% to 4% [18192021222324]; the rate of the historical control was 1.7%. These values indicate the effectiveness of RAPN for cancer control.…”

Section: Clinical Trial Of Rapn In Japanmentioning

confidence: 99%

Current status of robotic partial nephrectomy in Japan

Hinata

Fujisawa

2016

Investig Clin Urol

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The safety and efficacy of robot-assisted partial nephrectomy (RAPN) has been reported in Western countries. However, there are no similar reported studies of RAPN in Japan. Although common medical services are covered by public health insurance in Japan, RAPN had not been approved as a listed treatment for public insurance. We conducted a prospective clinical trial to confirm the efficacy and safety of RAPN in Japan. The aim of the present review article is to describe current status of RAPN in Japan and to introduce a part of clinical results obtained from the clinical trial. Based on the favorable results obtained in this clinical trial, RAPN was approved in April 2016 by the Japanese Ministry of Health, Labour and Welfare to be covered by public health insurance. This change allows access to RAPN to everyone in Japan, regardless of wealth. The RAPN techniques used in Japan are also reviewed.

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A Comparison of Robotic, Laparoscopic and Open Partial Nephrectomy

Abstract: Renal function preservation and complications were similar for robotic, laparoscopic, and open partial nephrectomy.

Cited by 71 publications

References 23 publications

Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis

Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis

The impact of non-hilar clamping open partial technique performed for the treatment of patients with small renal masses with lower R.E.N.A.L. nephrometry scores on renal functions during the early postoperative period

Current status of robotic partial nephrectomy in Japan

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