Advantages seen with robot-assisted nephrectomy for renal tumors

NEW YORK (Reuters Health) - As a treatment for renal tumors, robot-assisted partial nephrectomy (RAPN) offers comparable oncologic control as traditional laparoscopic nephrectomy, but with less blood loss, a shorter warm ischemia time, and a decreased hospital stay, new research shows.

The results also suggest that operative parameters for RAPN are less influenced by tumor complexity than those for laparoscopic nephrectomy.

"RAPN is rapidly emerging as an alternative to laparoscopic partial nephrectomy for the treatment of renal malignancy," Dr. Brian M. Benway, from Washington University School of Medicine, St. Louis, and colleagues explain. The present study is "the largest multi-institution comparison of the two approaches to date, describing outcomes from three experienced minimally invasive surgeons."

As reported in The Journal of Urology for September, the researchers compared the outcomes of 118 consecutive laparoscopic partial nephrectomies and 129 RAPNs that were performed at three academic centers from 2004 to 2008. The patient groups were comparable in terms of age, gender, body mass index, anesthetic risk, and radiographic tumor size.

The RAPN and laparoscopic nephrectomies were similar in overall operative time (189 vs. 174 minutes), collecting system entry (47% vs. 54%), pathologic tumor size (2.8 vs. 2.5 cm), and positive margin rate (3.9% vs. 1%). By contrast, RAPN was associated with lower operative blood loss (155 vs. 196 mL, p = 0.03), a decreased hospital stay (2.4 vs. 2.7 days, p < 0.0001), and a shorter warm ischemia time (19.7 vs. 28.4 minutes, p < 0.0001).

One intraoperative complication occurred in the laparoscopy group (adrenal injury) versus none in the RAPN group. The corresponding postoperative complication rates were 8.6% and 10.2%.

"This report is meaningful insofar as it is the first to suggest that the robotic approach appears to benefit experienced laparoscopic renal surgeons," Dr. Kevin C. Zorn, from the University of Chicago, writes in a related editorial. "However, it is important for readers to be cognizant that a well trained bedside assistant and support from a dedicated OR nursing team, coupled with robotic proficiency and nephron-sparing surgery experience, are crucial to ensure these favorable and consistent RAPN outcomes."

J Urol 2009;182:866-873.

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