Retroperitoneal robotic partial nephrectomy

Systematic review and cumulative analysis of comparative outcomes

Nicola Pavan, Ithaar Derweesh, Lance J. Hampton, Wesley White, James Porter, Benjamin J. Challacombe, Prokar Dasgupta, Riccardo Bertolo, Jihad Kaouk, Vincenzo Mirone, Francesco Porpiglia, Riccardo Autorino

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Objectives: To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). Materials and Methods: A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. Results: Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95% confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95% CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95% CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95% CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95% 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95). Conclusions: Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalJournal of Endourology
Volume32
Issue number7
DOIs
StatePublished - Jul 1 2018

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Robotics
Nephrectomy
Confidence Intervals
Length of Stay
Warm Ischemia
Neoplasms
Kidney Neoplasms
Operative Time
PubMed
Case-Control Studies
Odds Ratio
Databases

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Retroperitoneal robotic partial nephrectomy : Systematic review and cumulative analysis of comparative outcomes. / Pavan, Nicola; Derweesh, Ithaar; Hampton, Lance J.; White, Wesley; Porter, James; Challacombe, Benjamin J.; Dasgupta, Prokar; Bertolo, Riccardo; Kaouk, Jihad; Mirone, Vincenzo; Porpiglia, Francesco; Autorino, Riccardo.

In: Journal of Endourology, Vol. 32, No. 7, 01.07.2018, p. 591-596.

Research output: Contribution to journalReview article

Pavan, N, Derweesh, I, Hampton, LJ, White, W, Porter, J, Challacombe, BJ, Dasgupta, P, Bertolo, R, Kaouk, J, Mirone, V, Porpiglia, F & Autorino, R 2018, 'Retroperitoneal robotic partial nephrectomy: Systematic review and cumulative analysis of comparative outcomes', Journal of Endourology, vol. 32, no. 7, pp. 591-596. https://doi.org/10.1089/end.2018.0211
Pavan, Nicola ; Derweesh, Ithaar ; Hampton, Lance J. ; White, Wesley ; Porter, James ; Challacombe, Benjamin J. ; Dasgupta, Prokar ; Bertolo, Riccardo ; Kaouk, Jihad ; Mirone, Vincenzo ; Porpiglia, Francesco ; Autorino, Riccardo. / Retroperitoneal robotic partial nephrectomy : Systematic review and cumulative analysis of comparative outcomes. In: Journal of Endourology. 2018 ; Vol. 32, No. 7. pp. 591-596.
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title = "Retroperitoneal robotic partial nephrectomy: Systematic review and cumulative analysis of comparative outcomes",
abstract = "Objectives: To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). Materials and Methods: A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. Results: Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95{\%} confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95{\%} CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95{\%} CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95{\%} CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95{\%} 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95). Conclusions: Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.",
author = "Nicola Pavan and Ithaar Derweesh and Hampton, {Lance J.} and Wesley White and James Porter and Challacombe, {Benjamin J.} and Prokar Dasgupta and Riccardo Bertolo and Jihad Kaouk and Vincenzo Mirone and Francesco Porpiglia and Riccardo Autorino",
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T2 - Systematic review and cumulative analysis of comparative outcomes

AU - Pavan, Nicola

AU - Derweesh, Ithaar

AU - Hampton, Lance J.

AU - White, Wesley

AU - Porter, James

AU - Challacombe, Benjamin J.

AU - Dasgupta, Prokar

AU - Bertolo, Riccardo

AU - Kaouk, Jihad

AU - Mirone, Vincenzo

AU - Porpiglia, Francesco

AU - Autorino, Riccardo

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objectives: To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). Materials and Methods: A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. Results: Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95% confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95% CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95% CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95% CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95% 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95). Conclusions: Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.

AB - Objectives: To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). Materials and Methods: A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. Results: Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95% confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95% CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95% CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95% CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95% 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95). Conclusions: Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.

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