Conventional laparoscopy and da Vinci robot-assisted technique for partial nephrectomy: Comparison of indications and ciinical outcomes
10.3724/SP.J.1008.2013.00719
- Author:
Lin-Hui WANG
1
Author Information
1. Department of Urology, Changhai Hospital, Second Military Medical University
- Publication Type:Journal Article
- Keywords:
Daviti robot;
Kidney neoplasms;
Laparoscopy;
Partial nephrectomy
- From:
Academic Journal of Second Military Medical University
2013;34(7):719-726
- CountryChina
- Language:Chinese
-
Abstract:
Objeciive To investigate the cinnical benefits and role of robot-asiisted laparoscopic partial nephrectomy RAPN) by comparing the clinical data of patients receiving the RAPN or conventional laparoscopic partial nephrectomy (CLPN). Methods A retrospective analyris was performed for 67 patients who underwent either RAPN (n = 24) or CLPN (n = 43) between January 2011 and December 2012 at our institution. Preoperative dinical stages of both groups were T1N0M0. Univariate analytis and logistic regression modll were used to detect factors affecting indication sdection in RAPN. The intraoperative parameters and postoperative outcomes were compared between RAPN and CLPN groups matched for DAP score. Results Univariate and multivariate logistic regresion analytis revealed that DAP score (/3=1. 987, P = 0. 022, 95%CI[1. 34, 39. 79]) was the only predictor of RAPN approach in logistic regresion analytis. Only 38 DAP matched cases in RAPN (n = 19) and CLPN (= 19) were included for analytis, and the demographics were comparable between the matched two groups except for the preoperative estimated glomeruiar filtration rate (eGFR). One open converion was required in the RAPN group due to intra-operation bleeding, and all the cases were smoothly completed in the conventional iaparoscopic group. There were no significant differencesbetween the matched two groups regarding the estimated blood loss, time off oraHntake, highest visual analog pain scale, length of stay, comphcation rate or transfusion rate (all P>0. 05). Patients undergoing RAPN had a rigniticancly shorter warm ischemia time ([27. 0±5. 3] min vs [34. 2 ±7. 3] min, P<0. 05) and a longer operative time ([249. 5±49. 6] min vs [212. 9±57. 11] mi, P<0. 05) compared with CLPN group. The surgical margins were negative in both groups. During amean follow-up of (5. 6 ± 2. 2) months and (6. 6 ± 2. 6) months, only one tumor recurrence was notice in the CLPN group. At the last follow-up, the decrease percentage of eGFR was (12 ± 8)% in the RAPN group versus (17 ± 15)% in the CLPN group (P>0. 05). Conclusion RAPN requires a shorter warm ischemia time and provides a more rapid learning curve, good surgical safety and good short-term efficacy. For surgeons with experienced CLPN technique, they can use RAPN to treat Hgh-complexity tumorswhich are beyond the conventional laparoscopic technique.
