A Single Surgeon’s Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy

Abstract

Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities—open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n = 23), laparoscopic partial nephrectomy (LPN) (n = 48), and robotic partial nephrectomy (RPN) (n = 35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P = 0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P < 0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P = 0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

Laparoscopic Versus Open Partial Nephrectomy: A Systemic Review and Meta-Analysis of Surgical, Oncological, and Functional Outcomes

“…The characteristics of the included studies are shown in Supplementary Table 1. All the included studies-6 prospective studies (23)(24)(25)(26)(27)(28) and 20 retrospective studies (22,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)-were cohort observational studies with no randomization. There were 3292 and 4803 patients in the LPN and OPN groups, respectively.…”

“…What is more, the level of evidence for the outcomes was assessed using the framework in the Cochrane Handbook for Systematic Reviews of Interventions (22). A funnel plot was used to assess the risk of publication bias for outcomes that included at least 10 statistically significant studies.…”

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

“…Thirty‐four eligible studies included 60 808 patients who underwent PN, of whom 19 638 underwent RaPN with mean age 58.9 years and 41 170 underwent OPN with mean age 58.5 years. Table presents the baseline patient demographics of all enrolled studies.…”

Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique

“… 1 Retroperitoneoscopic nephron-sparing surgery (RPNSS) has the advantages of fast recovery, direct control of target organs, and reduced interference from the intestines compared with open or transperitoneal laparoscopic nephron-sparing surgery (LNSS). 2 – 6 Nevertheless, ensuring hemostatic control and reducing the warm ischemia time (WIT) remain the key surgical concerns in RPNSS. Laparoscopic knot-tying and suturing are the most difficult steps in decreasing the WIT and shortening the learning curve, making this procedure a challenging and highly advanced laparoscopic surgery for most urologists.…”