Technology & Instruments: Robotics/LaparoscopyModerated Poster 26: Monday, May 16, 2011: 8:00 AM-10:00 AM771 A COMPARISON OF PERI-OPERATIVE OUTCOMES OF ROBOT-ASSISTED AND PURE LAPAROSCOPIC PARTIAL NEPHRECTOMY
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INTRODUCTION AND OBJECTIVES
Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason is the desire for minimally invasive surgical approaches but the limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and thus may also do so for PN. To explore this we undertook a comparison of surgical outcomes of
METHODS
Using our institutional renal tumor database, we identified patients (pts) with a normal contralateral kidney who underwent RPN for a localized renal mass by a single surgeon who had performed <25 previously. A total of 45 patients were identified and compared to the last 45 similar patients who underwent LPN by a surgeon who had performed >150 previous LPNs. Surgical outcomes were compared between the 2 groups, including; warm ischemia time (WIT), surgical times, estimated blood loss (EBL),
RESULTS
Pre-operative patient and tumor characteristics were similar between the groups except tumor size, which was larger in the RPN group (3.5 vs. 2.7 cm, p=0.007). LOS, EBL, and transfusion rates were similar (p=0.162, p= 0.998, p=1.00, respectively). Unclamped pts were dropped from the analysis of WIT (14 RPN pts). Mean WIT was similar between the clamped RPN and LPNs (18 vs. 21 min., p=0.133 respectively). Room time was longer in the RPN group (295 vs. 231 min., p=0.003) but surgical times were
CONCLUSIONS
RPN is a safe option with peri-operative outcomes similar to those of LPN performed by an experienced surgeon. RPN may have a shorter learning curve as evidenced by the similar outcomes with larger lesions for a less experienced surgeon but with longer room times. The high PSM rate in the unclamped RAPN group is worrisome and has prompted a re-evaluation of technique at our institution.
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