Robotics and Laparoscopy
Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a)
Correspondence: Kamran Ahmed, MRC Centre for Transplantation, King's College London, King's Health Partners, St Thomas Street, London SE1 9RT, UK.
- To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta-analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies.
Materials and Methods
- A systematic review of the literature was performed to identify studies comparing LPN and RPN.
- Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected.
- Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected.
- A meta-analysis using random effect model was performed.
- A further Bland–Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques.
- Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN).
- There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] –12.01 to 104.26).
- Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI –15.22 to 3.70).
- Also, LOS (P = 0.22, 95% CI –0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI –0.05 to 0.06).
- Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient.
- Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.