90th Annual Meeting Abstracts
Robotic-Assisted Laparoscopic and Laparoscopic Partial Nephrectomy; A Comparison of a Single-Surgeon’s Experience
*Anne M Suskind, MD1, *Ryan C Jackson2, *Staff Ilene2, Shichman J Steven, MD2
1University of Connecticut, Farmington, CT;2Hartford Hospital, Hartford, CT
Objective: To compare the safety and efficacy of Robotic-Assisted Laparoscopic Partial Nephrectomy (RALPN) to the standard Laparoscopic Partial Nephrectomy (LPN).
Design: Comparison of RALPN (October 2007-March 2009) and LPN (October 2005-June 2008) in a single-surgeon series.
Setting: The general community in a private referral center.
Patients: 75 consecutive patients from each group.
Intervention: RALPN versus LPN.
Main Outcome Measures: Outcome measures defined at the onset of the study included demographic, operative, pathological, and follow-up data for patients undergoing RALPN and LPN. Variables were analyzed via Chi Square Test or T-test.
Results: Statistical analysis showed remarkable consistency between the two groups. Of note, estimated blood loss (EBL) was statistically different between the two groups; 357.26 cc (SD 345.177) in the LPN group and 257.13 cc (SD 188.277) in the RALPN group (P=0.044). Theres were 13 complications in the LPN group and 11 complications in the RALPN group. Major complications include 1 aneurysm in the RALPN group, 2 post-operative bleeds in each group, and 1 urine leak in the RALPN group. In the laparoscopic series, 1 case was converted to a hand assisted laparoscopic (HAL) procedure and 2 were converted to radical nephrectomies. In the robotic series, 1 case was converted to a standard laparoscopic procedure, and no cases were converted to either HAL or to radical nephrectomy. There was a modest decrease in clamp time and in hospital length of stay with the RALPN group (not statistically significant).
Conclusions: RALPN is a safe and effective alternative to standard LPN. With this hybrid approach, we feel that we are better poised to resect larger, more endophytic, and centrally located tumors than with the standard laparoscopic technique.