Comparison of Hand-Assisted Laparoscopic vs Robot-Assisted Laparoscopic vs Open Partial Nephrectomy in Patients with T1 Renal Masses

• Published in: Journal of endourology Vol. 31; no. 4; p. 374
• Main Authors: Han, Kyung-Sik, Song, Gee Hyun, You, Dalsan, Song, Cheryn, Jeong, In Gab, Hong, Jun Hyuk, Ahn, Hanjong, Kim, Choung-Soo, Hong, Bumsik
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Adult; Aged; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Dipyrone - therapeutic use; Female; Glomerular Filtration Rate; Hand-Assisted Laparoscopy - methods; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy - methods; Length of Stay; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Nephrectomy - methods; Operative Time; Pain, Postoperative - drug therapy; Postoperative Complications - epidemiology; Retrospective Studies; Robotic Surgical Procedures - methods; Time Factors; Warm Ischemia
• ISSN: 1557-900X
• DOI: 10.1089/end.2014.0517

To evaluate the validity of hand-assisted laparoscopic partial nephrectomy (HALPN) for small renal masses, patients who underwent HALPN, robot-assisted laparoscopic partial nephrectomy (RALPN), or open partial nephrectomy (OPN) at a single medical institution were compared in terms of perioperative outcomes. In this retrospective cohort study, all 590 consecutive patients who underwent HALPN (n=89), RALPN (n=147), or OPN (n=354) between July 2011 and April 2014 in a single institute were compared in terms of perioperative outcomes, including the mean operative time, warm ischemia time (WIT), length of the hospital stay, change in the estimated glomerulofiltration rate (eGFR), duration of analgesic use, surgical margins, and adverse events. The patient groups were compared by a multivariate regression model, in which adjustments were made for differences in baseline demographic and tumor characteristics. OPN associated with a significantly longer mean operative time (187 minutes) than RALPN (162 minutes; p<0.001) or HALPN (172 minutes; p=0.013), a longer hospital stay (7.3, 5.3, and 5.9 days, respectively; p<0.001 and <0.001, respectively), and a longer duration of analgesic use (6.6, 4.6, and 5.4 days, respectively; p<0.001 and <0.001, respectively). HALPN and RALPN were equivalent in terms of operative time. RALPN had a significantly longer WIT than HALPN and OPN (p<0.001 and <0.001, respectively). HALPN had a significantly longer hospital stay than RALPN (p=0.026). The three methods differed in terms of eGFR change (p=0.028), but multivariate analysis found that the surgical method was not a significant factor for eGFR. The three methods did not differ in terms of complication rates. HALPN associated with shorter operative and convalescence times compared with OPN. HALPN was generally not inferior to RALPN in terms of perioperative outcomes, although it associated with a longer convalescence.