Role of laparoscopy in the era of robotic surgery in urology in developing countries

Bansal, Devanshu; Chaturvedi, Saurabh; Maheshwari, Ruchir; Kumar, Anant

doi:10.4103/iju.iju_252_20

Cited by 14 publications

(4 citation statements)

References 69 publications

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“…1 Literature does show, however, that the robotic approach provides benefit over the other 2 techniques. 2 In this study, the authors did not demonstrate a difference in estimated bleeding between the intention to treat groups, although there was a significant difference in favor of laparoscopic PN when patients were analyzed according to treatment. It is possible that this was due to crossover determined by the attending surgeon in 7 cases, hence introducing a possible bias.…”

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confidence: 53%

“…1 Therefore, studies like ours attesting to the safety and effectivity of laparoscopic partial nephrectomy remain relevant not only in Brazil but also in other places where limitations on access to robotic surgery still exist. 2 We acknowledge that the length of stay in minimally invasive surgery should be much shorter than that observed in our study; however, our institute is a tertiary referral cancer center where most of our patients come from distant cities, and we established a protocol of hospitalization for greater safety for patients who normally have to travel long distances after hospital discharge.…”

Section: Reply By Authorsmentioning

confidence: 83%

“…First, none of these patients had a robotic-assisted laparoscopic surgery, a commonly used approach in the United States that has likely contributed to the increased use of partial nephrectomy over time. 1,2 Still, it is not likely that a laparoscopic and robotic-assisted laparoscopic partial nephrectomy would have substantially different outcomes in expert hands. 3 Second, most experienced centers that perform minimally invasive partial nephrectomy have a shorter hospital stay than what was described herein, potentially giving another edge to the minimally invasive approach.…”

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confidence: 99%

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Editorial Comment

Barbosa

2022

Journal of Urology

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This group from Brazil randomized 180 patients with cT1 renal masses to open or laparoscopic partial nephrectomy with the primary outcome of surgical complications, and secondary outcomes of recurrence rate and changes in renal function. Overall, their findings suggest that laparoscopic partial nephrectomy is a safe alternative to open surgery, and may be superior in preserving renal function and avoiding abdominal wall complications. While there are some notable limitations to this study, including early closure due to slow accrual and absence of patient reported outcomes (quality of life, functional status, pain etc), this was an impressive effort and the findings largely support those from larger observational studies, as referenced in the paper.However, the findings must also be put into the context of our current practice. First, none of these patients had a robotic-assisted laparoscopic surgery, a commonly used approach in the United States that has likely contributed to the increased use of partial nephrectomy over time. 1,2 Still, it is not likely that a laparoscopic and robotic-assisted laparoscopic partial nephrectomy would have substantially different outcomes in expert hands. 3 Second, most experienced centers that perform minimally invasive partial nephrectomy have a shorter hospital stay than what was described herein, potentially giving another edge to the minimally invasive approach. 4 It is not often that we have data from a surgical randomized, controlled trial to inform our practice. Given that many surgeons already use laparoscopic approaches to partial nephrectomy, these findings are not likely to be practice changing. But with the increasing emphasis on nephron-sparing surgery for patients with small localized renal tumors, 5 these results should give surgeons the confidence that a laparoscopic partial nephrectomy, with or without robotic assistance, is a safe and effective option for our patients.

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confidence: 53%

Section: Reply By Authorsmentioning

confidence: 83%

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confidence: 99%

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Editorial Comment

Barbosa

2022

Journal of Urology

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“…Moreover, laparoscopic surgery is more cost-effective [12]. Therefore, compared with robotic surgery, laparoscopic surgery is still the most mainstream option in China or other developing countries [13].…”

Section: Discussionmentioning

confidence: 99%

Assessment of umbrella-shaped layout for trocar puncture in pure laparoscopic partial nephrectomy with retroperitoneal approach

Ma,

Chen,

et al. 2023

Preprint

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Background Laparoscopic partial nephrectomy (LPN) is one of the main methods for treating renal cancer. There are many types of puncture hole layouts, and umbrella layouts are less commonly used. This study aimed to investigate the efficacy and safety of retroperitoneal LPN with an umbrella-shaped layout for localized renal cell carcinoma. Methods Eighty patients with stage T1a renal cancer who were admitted to our hospital from May 2017 to March 2021 and underwent retroperitoneal LPN were selected. Patients were divided into two groups according to the position of the puncture hole: Trapezoidal layout group and umbrella-shaped layout group. Demographic and clinical data were retrospectively analyzed. Results The warm ischemia times, operative times, and amount of blood loss for the trapezoidal and umbrella-shaped layout groups were 19.8 min and 15.8 min, 96.9 min and 85.0 min, and 86.2 ml and 73.5 ml, respectively; the differences were statistically significant (P < 0.05). The postoperative complication rates of the trapezoidal and umbrella-shaped layout groups were 20% (8/40) and 17.5% (7/40), respectively. The postoperative hospitalization periods of the trapezoidal and umbrella-shaped layout groups were 9.1 days and 8.9 days, respectively. At 6 months after surgery, the glomerular filtration rates (GFR) of the affected side of the trapezoidal and umbrella-shaped layout groups were decreased by 10.3 ml/min·1.73 m2 and 9.6 ml/min·1.73 m2; the differences were not statistically significant (P > 0.05). All pathological margins were negative. During postoperative follow-up, there was one case of recurrence in the trapezoidal layout group and no recurrence in the umbrella-shaped layout group. Conclusion The umbrella-shaped layout is safe and effective for retroperitoneal LPN and superior to the trapezoidal layout in terms of operative time, warm ischemia time, and blood loss.

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