Retroperitoneal versus Transperitoneal Robotic-Assisted Partial Nephrectomy : A Single-Institution Matched Pair Analysis

Robot-assisted partial nephrectomy is a minimally invasive treatment option for localized kidney tumors. It can be performed either via the more routinely used transperitoneal approach or the retroperitoneal approach.

We used a matched-pair analysis to evaluate and compare the retroperitoneal (RRPN) perioperative variables and the transperitoneal (TRPN) robot-assisted partial nephrectomy. 

We carried out a retrospective review of 224 patients who underwent robot-assisted partial nephrectomy between 2014 and 2019; 63 patients and 161 patients underwent retroperitoneal and transperitoneal approaches, respectively. A matched-pair analysis was performed on 51 pairs of patients. The matching criteria used were age, Charlson comorbidity index, BMI (Body Mass Index), the grade of renal insufficiency, tumor diameter, and PADUA score.  

 In the group with retroperitoneal access, the time to reach the renal hilum (p<0.001), the overall complication rate (p= 0.008), and the major complication rate (p=0.01) were significantly lower compared to the transperitoneal group. 

The operative time was 143 vs. 150 minutes (p= 0.63) in RRPN vs. TRPN, respectively. Warm ischemia time was 10 minutes in RRPN vs. 12 minutes in TRPN (p= 0.07). Early unclamping was used in 71% in RRPN vs. 48% in TRPN (p=0.02). The Length of hospital stay was six days in both groups (p=0.11). The cases' complexity, the rate of positive surgical margins, and postoperative kidney function were comparable in both groups (p> 0.05).


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