Comparison of Minimally Invasive Surgical Approaches in the Management of Small Renal Masses at a Safety Net Hospital

Abstract

Partial nephrectomy can be performed with traditional straight laparoscopy (SL), hand-assisted laparoscopic (HAL) and robotic-assisted laparoscopic (RAL) techniques. The purpose of this study is to analyze trends in surgical technique and compare the intra-and post-operative outcomes at a safety net hospital. We performed a single-institution retrospective review of intra-and post-operative outcomes in partial nephrectomy cases between 2012 and 2018. We analyzed the impact of patient demographics, tumor characteristics, and RENAL nephrometry score on surgical outcomes and post-operative complications among the three surgical approaches to partial nephrectomy. Of the 164 partial nephrectomies, 36 were SL, 65 HAL, and 63 RAL. Most SL was performed in the early years, whereas most RAL was performed in the later years, and HA was evenly distributed throughout the years. There was no difference in demographics, intra-operative complications, estimated blood loss, or positive margin rates between SL, HAL, and RAL. HAL partial nephrectomies had a higher RENAL nephrometry score and had statistically significant less warm ischemia and operative times when compared to RAL. HAL is a worthwhile technique in larger and more complex masses and especially in settings where robotic surgery is unable to be performed.