Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis

Carbonara, Umberto; Eun, Daniel; Derweesh, Ithaar; Capitanio, Umberto; Celia, Antonio; Fiori, Cristian; Checcucci, Enrico; Lee, Jennifer; Larcher, Alessandro; Patel, Devin; Meagher, Margaret; Crocerossa, Fabio; Veccia, Alessandro; Hampton, Lance J.; Montorsi, Francesco; Porpiglia, Francesco; Autorino, Riccardo

doi:10.1007/s00345-021-03741-2

Cited by 13 publications

(16 citation statements)

References 30 publications

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“…Previously, many studies have compared the outcomes between TRPN and RRPN for patients with renal masses ( 8 – 13 , 24 , 25 ). Most of them have identified advantages of RRPN, such as shorter operating time and ischemia time, less blood loss, and shorter hospital stay, especially for lateral or posterior tumors.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors

Zhao

et al. 2022

Front. Oncol.

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ObjectivesWe compared the outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) for complete upper pole renal masses (1 point for the “L” component of the RENAL scoring system).Material and MethodsWe retrospectively reviewed patients who underwent either TRPN or RRPN from 2013 to 2016. Baseline demographics and perioperative, functional, and oncological results were compared. Multivariable analysis was performed to identify factors related to pentafecta achievement (ischemia time ≤25 min, negative margin, perioperative complication free, glomerular filtration rate (eGFR) preservation >90%, and no chronic kidney disease upstaging).ResultsNo significant differences between TRPN vs. RRPN were noted for operating time (110 vs. 114 min, p = 0.870), renal artery clamping time (19 vs. 18 min, p = 0.248), rate of positive margins (0.0% vs. 3.3%, p = 0.502), postoperative complication rates (25.0% vs. 13.3%, p = 0.140). TRPN was associated with a more estimated blood loss (50 vs. 40 ml, p = 0.004). There were no significant differences in pathologic variables, rate of eGFR decline for postoperative 12-month (9.0% vs. 7.1%, p = 0.449) functional follow-up. Multivariate analysis identified that only RENAL score (odd ratio: 0.641; 95% confidence interval: 0.455–0.904; p = 0.011) was independently associated with the pentafecta achievement.ConclusionsFor completely upper pole renal masses, both TRPN and RRPN have good and comparable results. Both surgical approaches remain viable options in the treatment of these cases.

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Section: Discussionmentioning

confidence: 99%

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors

Zhao

et al. 2022

Front. Oncol.

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“…Our initial research identified 1957 studies. After initial screening and full-text review, 17 studies, which were published between 2013 and 2021, were identified ( Table 1 ) [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . A single study was a prospective nonrandomized study [10] .…”

Section: Resultsmentioning

confidence: 99%

“…A single study was a prospective nonrandomized study [10] . Seven were observational retrospective case-control studies [5] , [6] , [11] , [13] , [14] , [15] , [16] , nine were retrospectively matched pair cohort studies [7] , [8] , [9] , [12] , [17] , [18] , [19] , [20] , [21] . No randomized controlled trial was included in the present review.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 6266 patients included in the meta-analysis, 2261 (36.1%) and 4005 (63.9%) underwent R-RAPN and T-RAPN, respectively [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] . There was no statistically significant difference between groups in terms of age ( p = 0.1) [5] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , BMI ( p = 0.8) [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [16] , [17] , [19] , [21] , ASA score ( p = 0.9) [5] , [9] , [12] , [13] , [16] , [17] , [20] , RENAL score ( p = 0.07) [5] , [6] , [7] , [8] , [10] , [11] , [13] , [14] , ...…”

Section: Resultsmentioning

confidence: 99%

“…While the core operative principles for both approaches are similar, important differences exist in terms of patient positioning, working space creation/port placement, and key anatomical landmarks [4] . The selection of the optimal approach plays a critical role in renal surgery, and the debate for defining the role of retroperitoneal and transperitoneal techniques is still ongoing, as shown by the increasing comparative studies over the past few years [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”

Section: Introductionmentioning

confidence: 99%

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Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes

Carbonara

Crocerossa

Campi

et al. 2022

European Urology Open Science

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A novel mini‐retractor for retroperitoneal laparoscopic partial nephrectomy

Lu,

Guo,

Yang

et al. 2024

Journal of Surgical Oncology

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BackgroundRetroperitoneal partial nephrectomy (RLPN) is the premier treatment for localized renal tumors despite narrow operation space. Many efforts have been taken to facilitate the operation of RLPN, but the optimal resolution remains debatable.ObjectiveTo explore the feasibility of using Mini‐lap to improve workspace and surgical vision in RLPN.Design, Setting, and ParticipantsA multicenter retrospective review of 51 patients who underwent RLPN with Mini‐lap from January 2018 to December 2020 was conducted.Surgical ProcedureStandard RLPN under three poles was performed in all cases. We highlighted the usage of Mini‐lap (Teleflex Minilap percutaneous Surgical System) as a novel retractor in RLPN.Outcome and Measurements and Statical AnalysisDemographics, preoperative, intraoperative, and postoperative outcomes were assessed.Results and LimitationsAll 51 cases completed RLPN with three ports successfully and no conversion to open surgery. The mean diameter of tumors was (3.53 ± 1.05) cm, in which 62.7% (32/51) were located anteriorly. The operation time and warm ischemic time (WIT) were (86.7 ± 15.9) min and (25.6 ± 5) min respectively. Minor complications (Clavien grade 1−2) occurred in 6 cases. The limitations were small sample size, retrospective design, and absence of control.ConclusionsMini‐lap could be used as a mini‐retractor in RLPN, sparing extra assistant ports, expanding workspace, and optimizing vision.Patient SummaryWith highlights of larger workspace and less instrument interference, mini‐lap could be applied in retroperitoneal laparoscopic partial nephrectomy.

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Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis

Cited by 13 publications

References 30 publications

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors

Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes

A novel mini‐retractor for retroperitoneal laparoscopic partial nephrectomy

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