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Xu P, Luo J, Shuai H, Cai T, Cui S, Zhou L, Xu Q, Zhao Y, Chen T, Shan W, Wu T. Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis. J Robot Surg 2024; 18:186. [PMID: 38683492 DOI: 10.1007/s11701-024-01963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
The study aims to assess the available literature and compare the perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) for posterior-lateral renal tumors using transperitoneal (TP) and retroperitoneal (RP) approaches. Systematically searched the Embase, PubMed, and Cochrane Library databases for literature. Eligible studies were those that compared TP-RAPN and RP-RAPN for posterior-lateral renal tumors. The data from the included studies were analyzed and summarized using Review Manager 5.3, which involved comparing baseline patient and tumor characteristics, intraoperative and postoperative outcomes, and oncological outcomes. The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). Both groups showed no significant differences in age, gender, BMI, R.E.N.A.L. score, and tumor size. Notably, compared to TP-RAPN, the RP-RAPN group demonstrated shorter operative time (OT) (MD: 17.25, P = 0.01), length of hospital stay (LOS) (MD: 0.37, P < 0.01), and lower estimated blood loss (EBL) (MD: 15.29, P < 0.01). However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). The systematic review and meta-analysis suggests RP-RAPN may be more advantageous for posterior-lateral renal tumors in terms of OT, EBL, and LOS, but no significant differences were found in WIT, overall complications, major complications, and PSM. Both surgical approaches are safe, but a definitive advantage remains uncertain.
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Affiliation(s)
- Pengjun Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jia Luo
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Cai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Shu Cui
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lin Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Qian Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yuxin Zhao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Wang Shan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China.
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China.
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Heining FM, Bieri U, Niemann T, Maletzki P, Tschung C, Adank JP, Rössler F, Nocito A, Hefermehl LJ. The Transabdominal Lumbar Approach (TALA) for Robotic Renal Surgery-A Retrospective Single-Center Comparative Study and Step-by-Step Description of a Novel Approach. Cancers (Basel) 2024; 16:446. [PMID: 38275887 PMCID: PMC10814128 DOI: 10.3390/cancers16020446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
The transperitoneal approach (TP) and the retroperitoneal approach (RP) are two common methods for performing nephrectomy or partial nephrectomy. However, both approaches face difficulties, such as trocar placement and limited working space (RP). TP is impaired in the case of dorsal tumors and dissection of the renal artery can be challenging due to the anatomic localization dorsally to the renal vein. A hybrid approach that combines both methods has been previously reported in a case series, but not evaluated systematically. This study proposes a modified hybrid approach, which we call the transabdominal lumbar approach (TALA), involving late robotic docking after elaborating the retroperitoneum using conventional laparoscopy. The study compares the last 20 consecutive patients who underwent RP and the last 20 patients who underwent TALA at our institution. The investigated variables include operative time and amount of blood loss, hospitalization duration, postoperative analgesia requirement, and postoperative complications. The study found no significant difference in operative time, blood loss, ischemia time, or hospital stay between the two groups. The TALA group had fewer complications regarding Clavien-Dindo category 3, but one complication of category 4. In Conclusion, TALA is a safe and promising approach that combines the advantages of RP and TP.
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Affiliation(s)
- Franziska Maria Heining
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
| | - Uwe Bieri
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, 5404 Baden, Switzerland;
| | - Philipp Maletzki
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
| | - Christopher Tschung
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
| | - Jean-Pascal Adank
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
| | - Fabian Rössler
- Department of Surgery and Transplantation, University Hospital Zürich, University of Zürich, 8006 Zürich, Switzerland;
| | - Antonio Nocito
- Department of Surgery, Kantonsspital Baden, 5404 Baden, Switzerland;
| | - Lukas John Hefermehl
- Department of Surgery, Division of Urology, Kantonsspital Baden, 5404 Baden, Switzerland; (F.M.H.); (U.B.); (P.M.); (J.-P.A.)
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Sri D, Malki M, Sarkar S, Ni Raghallaigh H, Oakley J, Kalsi M, Emara A, Hussain M, Barber NJ. Long term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift? J Robot Surg 2023; 17:2001-2008. [PMID: 37106313 DOI: 10.1007/s11701-023-01582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023]
Abstract
Although retroperitoneal surgery has demonstrated a better quality of recovery compared to transperitoneal routes, Retroperitoneal Robot Assisted Partial Nephrectomy (RRAPN) remains proportionally infrequent. As the boundaries of what is achievable robotically continue to be pushed, we present our experience at a high-volume tertiary referral centre that specialises in retroperitoneal surgery, exploring its feasibility as standard of care in the management of small renal masses. A prospective database of 784 RAPNs (2009-2020) was reviewed and 721 RRAPNs (92%) were performed at our centre. In our practice, we utilise a four-port approach to RRAPN. Patient, tumour and operative characteristics were assessed and both oncological outcomes and trifecta and pentafecta achievements were determined. Pentafecta was defined as achieving trifecta (negative surgical margin, no post-operative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Multivariate analysis was conducted to predict peri-operative factors which may prevent achieving a trifecta/pentafecta outcome. From 784 cases, 112 RAPNs were performed for imperative reasons, whilst the remainder were elective. Mean BMI ± s.d amongst our cohort was 28.6 ± 5.7. Mean tumour size was 3.1 cm (range 0.8-10.5 cm) and 47% of cases were stratified as intermediate/high risk using R.E.N.A.L nephrometry scoring. Forty-six patients had lesions in a hilar location, and 31% were anterior. Median blood loss was 30mls, with an open conversion rate of 1% and transfusion rate of 1.6%. Median warm ischaemic time (WIT) was 21 min, positive surgical margins were found in 4% and our post-operative Clavien 3/ > complication rate was 2.6%. We had a 1-day median length of stay with a 30 day readmission rate of 2%. Of 631 patients (80%) with a definitive histological diagnosis of cancer, 23% had T1b/ > disease. Over a mean 15 month follow-up period (range 1-125 months), 2% of patients developed recurrences and our cohort demonstrated a 99% 5 year cancer specific survival. Trifecta was achieved in 67% of cases and pentafecta in 47%. Age (p = 0.05), operative time (p = 0.008), pT1b tumours (p = 0.03), R.E.N.A.L score and blood loss (p = 0.001) were found to statistically significantly influence achievement of trifecta. Pentafecta achievement was influenced by R.E.N.A.L score (p = 0.008), operative time (p = 0.001) and blood loss (p = 0.001). We demonstrate the retroperitoneal approach in RAPN is feasible and safe irrespective of lesion location and complexity. In the hands of high-volume centres that are skilled in the retroperitoneal approach the benefits of retroperitoneal surgery can be extended even to challenging cohorts of patients without compromising their oncological or functional outcomes.
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Affiliation(s)
- D Sri
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK.
| | - M Malki
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - S Sarkar
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - H Ni Raghallaigh
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - J Oakley
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - M Kalsi
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - A Emara
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - M Hussain
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - N J Barber
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
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Mjaess G, Bernhard JC, Khene ZE, Doumerc N, Vaessen C, Henon F, Bruyere F, Brenier M, Parier B, Albisinni S, Ingels A. Retroperitoneal vs. transperitoneal robotic partial nephrectomy: a multicenter propensity-score matching analysis (PADORA Study - UroCCR n° 68). Minerva Urol Nephrol 2023; 75:434-442. [PMID: 37530660 DOI: 10.23736/s2724-6051.23.05346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Robot-assisted partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. This study aimed to compare the rate of trifecta achievement between retroperitoneal (RRPN) and transperitoneal (TRPN) robot-assisted partial nephrectomy using a large multicenter prospectively-maintained database and propensity-score matching analysis. METHODS This study was launched by the French Kidney Cancer Research Network, under the UroCCR Project (NCT03293563). Patients who underwent TRPN or RRPN by experienced surgeons in 15 participating centers were included. Data on demographic and clinical parameters, tumor characteristics, renal function, and surgical parameters were collected. The primary outcome was the rate of trifecta achievement, which was defined as a warm ischemia time of less than 25 minutes, negative surgical margins, and no major complications. Secondary outcomes included operative time, hospital length-of-stay, blood loss, postoperative complications, postoperative renal function, and each trifecta item taken alone. Subgroup analysis was done according to tumor location. RESULTS A total of 2879 patients (2581 TRPN vs. 298 RRPN) were included in the study. Before matching, trifecta was achieved in 73.0% of the patients in the TRPN group compared to 77.5% in the RRPN group (P=0.094). After matching 157 patients who underwent TRPN to 157 patients who underwent RRPN, the trifecta rate was 82.8% in the TRPN group vs. 84.0% in the RRPN group (P=0.065). The RRPN group showed shorter operative time (123 vs. 171 min; P<0.001) and less blood loss (161 vs. 293 mL; P<0.001). RRPN showed a higher trifecta achievement for posterior tumors than TRPN (71% vs. 81%; P=0.017). CONCLUSIONS RRPN is a viable alternative to the transperitoneal approach, particularly for posterior renal tumors, and is a safe and effective option for partial nephrectomy.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Brussels University Hospital, Brussels, Belgium -
| | | | | | | | | | | | | | - Martin Brenier
- Department of Urology, Hôpital Saint Joseph, Paris, France
| | - Bastien Parier
- Department of Urology, Hôpital Kremlin Bicêtre, Paris, France
| | - Simone Albisinni
- Department of Urology, Brussels University Hospital, Brussels, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Alexandre Ingels
- Department of Urology, CHU Henri Mondor, Créteil, France
- Inserm, Clinical Investigation Center 1430, Henri Mondor University Hospital, AP-HP, Creteil, France
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Lyu X, Jia Z, Ao L, Ren C, Wu Y, Xu Y, Chen K, Gao Y, Wang B, Ma X, Zhang X. Robot-assisted partial nephrectomy: Can retroperitoneal approach suit for renal tumors of all locations?-A large retrospective cohort study. BMC Urol 2022; 22:202. [PMID: 36496356 PMCID: PMC9741774 DOI: 10.1186/s12894-022-01128-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to explore the appropriate location of renal tumors for retroperitoneal approach. MATERIALS AND METHODS We retrospectively analyzed 1040 patients with renal tumor who were treated at our institution from Janurary 2015 to June 2020 and had underwent retroperitoneal robotic assisted-laparoscopic partial nephrectomy (rRAPN). Clinical features and postoperative outcomes were evaluated. RESULTS Patients with incomplete data were excluded, and we included 896 patients in total. The median tumor size was 3.0 (range: 0.8-10.0) cm. The median RENAL Nephrometry Score was 7 (range: 4-11), and the median PADUA Nephrometry Score was 8 (range: 6-14). The median surgical time was 120 min, and the median warm ischemia time was 18 min. The median estimated blood loss was 50 ml. The follow-up time was 20.2 (range: 12-69) months. The mean change of eGFR 1 year after operation was 14.6% ± 19.0% compared with preoperative estimated glomerular filtration rate (eGFR). When compared the tumor at different locations, as superior or inferior pole, anterior of posterior face of kidney, there were no significant differences of intra- and post-operative outcomes such as surgical time, warm ischemia time, estimated blood loss, removal time of drainage tube and catheter, postoperative feeding time and hospital stay, and changes of eGFR one year after surgery. We also compared tumors at special locations as endophytic or exophytic, anterior of posterior hilus of kidney, there were no significant differences in surgical time, warm ischemia time, estimated blood loss and changes of eGFR. There was no significant difference in intraoperative features and postoperative outcomes when tumor larger than 4 cm was located at different positions of kidney. Though the surgical time was longer when BMI ≥ 28 (132.6 min vs. 122.5 min, p = 0.004), no significant differences were observed in warm ischemia time, estimated blood loss, changes in eGFR. Twenty-seven patients (3.0%) had tumor progression, including 8 (0.9%) recurrence, 19 (2.1%) metastasis, and 9 (1.0%) death. CONCLUSION Retroperitoneal approach for RAPN has confirmed acceptable intra- and postoperative outcomes and suits for renal tumors of all different locations. Large tumor size and obesity are not contraindications for rRAPN.
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Affiliation(s)
- Xiangjun Lyu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Zhuo Jia
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Liyan Ao
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Changhao Ren
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yangyang Wu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yunlai Xu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Ke Chen
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yu Gao
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Baojun Wang
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Xin Ma
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Xu Zhang
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
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Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes. EUR UROL SUPPL 2022; 40:27-37. [PMID: 35515269 PMCID: PMC9062267 DOI: 10.1016/j.euros.2022.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/20/2023] Open
Abstract
Context Robot-assisted partial nephrectomy (RAPN) has gained increasing popularity as primary minimally invasive surgical treatment for localized renal tumors, and it has preferably been performed with a transperitoneal approach. However, the retroperitoneal approach represents an alternative approach given potential advantages. Objective To provide an updated analysis of the comparative outcomes of retroperitoneal RAPN (R-RAPN) versus transperitoneal RAPN (T-RAPN). Evidence acquisition A systematic review of the literature was performed up to September 2021 using MEDLINE, EMBASE, and Web of Science databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A sensitivity analysis was performed considering only matched-pair studies. Evidence synthesis Seventeen studies, which were published between 2013 and 2021, were retrieved. None of them was a randomized clinical trial. Among the 6,266 patients included in the meta-analysis, 2261 (36.1%) and 4,005 (63.9%) underwent R-RAPN and T-RAPN, respectively. No significant difference was found in terms of baseline features. The T-RAPN group presented a higher rate of male patients (odds ratio [OR]: 0.86, p = 0.03) and larger tumor size (weighted mean difference [WMD]: 0.2 cm; p = 0.003). The R-RAPN group reported more frequent posterior renal masses (OR: 0.23; p < 0.0001). The retroperitoneal approach presented lower estimated blood loss (WMD: 30.41 ml; p = 0.001), shorter operative time (OT; WMD: 20.36 min; p = 0.0001), and shorter length of stay (LOS; WMD: 0.35 d; p = 0.002). Overall complication rates were 13.7% and 16.05% in the R-RAPN and T-RAPN groups, respectively (OR: 1.32; p = 0.008). There were no statistically significant differences between the two groups regarding major (Clavien-Dindo classification ≥3 grade) complication rate, “pentafecta” achievement, as well as positive margin rates. When considering only matched-pair studies, no difference between groups was found in terms of baseline characteristics. Posterior renal masses were more frequent in the R-RAPN group (OR: 0.6; p = 0.03). Similar to the analysis of the entire cohort, R-RAPN reported lower EBL (WMD: 35.56 ml; p < 0.0001) and a shorter OT (WMD: 18.31 min; p = 0.03). Overall and major complication rates were similar between the two groups. The LOS was significantly lower for R-RAPN (WMD: 0.46 d; p = 0.02). No statistically significant difference was found between groups in terms of overall PSM rates. Conclusions R-RAPN offers similar surgical outcomes to T-RAPN, and it carries potential advantages in terms of shorter OT and LOS. Available evidence remains limited by the lack of randomized clinical trials. Patient summary In this review of the literature, we looked at comparative outcomes of two surgical approaches to robot-assisted partial nephrectomy. We found that the retroperitoneal technique offers similar surgical outcomes to the transperitoneal one, with potential advantages in terms of shorter operative time and length of hospital stay.
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Timsit MO, Terrier N, Toinet T, Dariane C, Debedde E, Panthier F, Thiounn N, Audenet F, Méjean A. Posterior transperitoneal robot-assisted partial nephrectomy in the treatment of renal tumors: Feasibility of a hybrid approach. Prog Urol 2022; 32:217-225. [DOI: 10.1016/j.purol.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Carbonara U, Eun D, Derweesh I, Capitanio U, Celia A, Fiori C, Checcucci E, Amparore D, Lee J, Larcher A, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Montorsi F, Porpiglia F, Autorino R. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 2021; 39:4175-4182. [PMID: 34050813 DOI: 10.1007/s00345-021-03741-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared. RESULTS Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7). CONCLUSION r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Devin Patel
- Department of Urology, UCSD, San Diego, CA, USA
| | | | | | | | - Lance J Hampton
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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Boga MS, Ates M. Retroperitoneal robot-assisted laparoscopic partial nephrectomy for posterior located renal tumours: Technique and early term outcomes. Int J Clin Pract 2021; 75:e13851. [PMID: 33237611 DOI: 10.1111/ijcp.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Traditionally, the trans-peritoneal approach is preferred for robot-assisted partial nephrectomy (RPN). However, retroperitoneal RPN (RP-RPN) has recently become widespread because of the advantages of easier access to the hilum, ease dissection of posterior tumours, and lower probability of intra-peritoneal organ injury. We aimed to present our initial experience of the RP-RPN series in posteriorly located renal tumours. METHODS Twenty-one patients were included in the study, who underwent RP-RPN by a single surgeon between July 2019 and January 2020. RP-RPN was carried out only in posteriorly located renal tumours with ischemic (on-clamp) or zero ischemic (off-clamp) techniques. Patients with solitary kidney and a history of previous retroperitoneal surgery in the lumbodorsal region were excluded from the study. RESULTS All cases completed without any operative complication and conversion to open or radical nephrectomy. Seven cases were completed as zero ischemic and 14 cases as ischemic technique. The mean operation time was 157.86 ± 64.24 minutes and estimated blood loss was 173.81 ± 136.84 mL. The mean warm ischemia time was 15.81 ± 12.42 minutes. Positive surgical margin observed in 4.8% of the patients. The mean length of stay was 3.33 ± 0.79 days. The mean estimated glomerular filtration rate (eGFR) change in the 3rd postoperative month was -3.71 ± 8.57 ml/min/1.73 m2 (4.6%). Mean follow-up period was 10.29 ± 4.86 months. New-onset stage 3-4 chronic kidney disease (eGFR < 60 m /min/1.73m2 ) was not observed during the follow-up period. CONCLUSION RP-RPN is a safe and feasible approach with acceptable oncological and functional results. We think that RP-RPN can be applied as an alternative to the trans-peritoneal approach for selected cases, especially in renal tumours with the posterior location.
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Affiliation(s)
- Mehmet Salih Boga
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ates
- Department of Urology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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10
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McDonald M, D Shirk J. Application of Three-Dimensional Virtual Reality Models to Improve the Pre-Surgical Plan for Robotic Partial Nephrectomy. JSLS 2021; 25:JSLS.2021.00011. [PMID: 34354337 PMCID: PMC8325483 DOI: 10.4293/jsls.2021.00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Objectives: Minimally invasive surgery for renal masses is complex and relies on two-dimensional (2D) computer tomography (CT) and magnetic resonance imaging (MRI) scans for surgical planning. We sought to determine if three-dimensional (3D) virtual reality (VR) models generated from imaging of patients undergoing robotic partial nephrectomy influenced presurgical planning approaches when compared to routine planning. Methods: The initial 15 patients underwent robotic assisted laparoscopic partial nephrectomy performed by one urologic surgeon. All patients pre-operatively underwent a CT and/or MRI scan. A pre-operative surgical plan was then recorded. 3D VR models were generated from these scans and reviewed. A second surgical plan was developed based on the 3D VR images. A comparison was made between the two studies prior to surgical intervention. All final surgical plans were implemented based on the 3D VR imaging studies. Results: Six surgical approaches were changed based on the 3D VR images. Two surgical approaches were changed from a transperitoneal to a retroperitoneal approach and two from a retroperitoneal to a transperitoneal approach. Two patients had distinctive renal vasculature related to the renal cancers which were not appreciated on routine scans but were well delineated by VR imaging studies. As a result, the surgical approach for two patients was altered to accommodate the new findings. Conclusion: Operative planning is paramount when performing robotic partial nephrectomy and developing a 3D surgical approach from 2D imaging can be difficult. Three-dimensional VR models affords the surgeon a 3D view prior to and during surgery and can ensure the selection of the appropriate surgical approach.
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Affiliation(s)
- Michael McDonald
- Department of Surgery, University of Central Florida, 400 Celebration Pl, Celebration, FL
| | - Joseph D Shirk
- UCLA Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Los Angeles, CA
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Bukavina L, Mishra K, Calaway A, Ponsky L. Robotic Partial Nephrectomy: Update on Techniques. Urol Clin North Am 2020; 48:81-90. [PMID: 33218596 DOI: 10.1016/j.ucl.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Surgical techniques for robot-assisted partial nephrectomy are driven by the aims of simplifying the most challenging surgical steps, maximizing functional and oncologic outcomes, and consistently pushing the envelope on possibilities. Over the past several years, we have seen an emergence in not only innovation in surgical technique, and robotic platforms, but integration of a variety of imaging techniques. We believe with developing robotic expertise, practicing urologists will continue to push the envelope in nephron preservation and complication-free recovery.
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Affiliation(s)
- Laura Bukavina
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kirtishri Mishra
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam Calaway
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lee Ponsky
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Suite 411, Cleveland, OH 44106, USA.
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12
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Ferakis N, Katsimantas A, Charalampogiannis N, Paparidis S, Rassweiler JJ, Gozen AS. Transperitoneal and retroperitoneal approach in laparoscopic partial nephrectomy for posterior cT1 renal tumors: A retrospective, two-centers, comparative study. ACTA ACUST UNITED AC 2020; 92. [PMID: 33016053 DOI: 10.4081/aiua.2020.3.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/22/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To compare perioperative, oncological and functional outcomes of Laparoscopic Transperitoneal Partial Nephrectomy (LTPN) and Retroperitoneal Laparoscopic Partial Nephrectomy (LRPN) for posterior, cT1 renal masses (RMs). MATERIALS AND METHODS Databases of two urologic institutions applying different laparoscopic surgical approaches on posterior cT1 RMs between June 2016 and November 2018 were retrospectively evaluated. Data on patient demographics, perioperative data and tumor histology were collected and further analyzed statistically. RESULTS Each group consisted of 15 patients. Baseline characteristics were comparable in each group. When compared to LTPN, LRPN was associated with significantly shorter operative time (OT) (115 min versus 199 min, p < 0.05). No significant differences were detected in the other outcomes. CONCLUSIONS LRPN is associated with a significantly shorter OT compared to LTPN for posterior cT1 RMs. Both surgical approaches are safe, feasible and credible, demonstrating optimal results.
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Affiliation(s)
- Nikolaos Ferakis
- Department of Urology, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens.
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13
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Harke NN, Darr C, Radtke JP, von Ostau N, Schiefelbein F, Eraky A, Hamann C, Szarvas T, Hadaschik BA, Tropmann-Frick M, Juenemann KP, Schoen G, Osmonov D. Retroperitoneal Versus Transperitoneal Robotic Partial Nephrectomy: A Multicenter Matched-pair Analysis. Eur Urol Focus 2020; 7:1363-1370. [PMID: 32912841 DOI: 10.1016/j.euf.2020.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND With increasing acceptance of robotic partial nephrectomy over the last decade, there is an ongoing discussion about the transperitoneal versus retroperitoneal access. OBJECTIVE To report outcomes after transperitoneal (TRPN) versus retroperitoneal (RRPN) robotic partial nephrectomy. DESIGN, SETTING, AND PARTICIPANTS A total of 754 patients were identified from the databases of three high-volume centers who underwent either TRPN (n = 551) or RRPN (n = 203). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Perioperative data were evaluated retrospectively. A propensity score matched-pair analysis was performed with the following variables: grade of renal insufficiency, age, body mass index, tumor diameter, and preoperative aspects and dimensions used for an anatomical (PADUA) score with a subsequent subgroup analysis for tumor location. For quality outcomes, the margin, ischemia, and complications (MIC) criteria were used (negative margins, ischemia time <20 min, and no major complications). Statistical analyses included chi-square and Mann-Whitney U tests. RESULTS AND LIMITATIONS In all, 176 patients could be matched in each group. The median tumor diameter was 28 mm with a PADUA score of 9. In 11% of RRPN versus 44% of TRPN cases, an anterior tumor location was found, and in 55% versus 30%, a posterior lesion was found (p < 0.001). Operative time (119 vs 139 min, p < 0.001) and warm ischemia time (9 vs 10 min, p = 0.003) were significantly shorter for RRPN. No significant differences were observed between intra- and postoperative complication rates, with 8% major complications in TRPN versus 3% in RRPN (p = 0.06). The MIC criteria were achieved in 90% in the RRPN versus 88% in the TRPN group, without differences for tumor location. CONCLUSIONS Significant differences between TRPN and RRPN could be found for intraoperative time, while complication rates and quality outcomes were comparable. RRPN can also be a considerable alternative for anterior tumors. PATIENT SUMMARY In this study, we demonstrate that robotic partial nephrectomy is feasible with either a transperitoneal or a retroperitoneal surgical access. The posterior approach can also be used for anterior renal tumors and may result in shorter operative time.
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Affiliation(s)
- Nina N Harke
- Department of Urology, University Hospital Essen, Essen, Germany.
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Nicola von Ostau
- Department of Urology, University Hospital Essen, Essen, Germany
| | | | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Claudius Hamann
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, Essen, Germany; Department of Urology, Semmelweis University, Budapest, Hungary
| | | | | | | | - Georg Schoen
- Department of Urology, Missioklinik, Wuerzburg, Germany; Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
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Porpiglia F, Checcucci E, Amparore D, Piramide F, Volpi G, Granato S, Verri P, Manfredi M, Bellin A, Piazzolla P, Autorino R, Morra I, Fiori C, Mottrie A. Three-dimensional Augmented Reality Robot-assisted Partial Nephrectomy in Case of Complex Tumours (PADUA ≥10): A New Intraoperative Tool Overcoming the Ultrasound Guidance. Eur Urol 2019; 78:229-238. [PMID: 31898992 DOI: 10.1016/j.eururo.2019.11.024] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite technical improvements introduced with robotic surgery, management of complex tumours (PADUA score ≥10) is still a matter of debate within the field of transperitoneal robot-assisted partial nephrectomy (RAPN). OBJECTIVE To evaluate the accuracy of our three-dimensional (3D) static and elastic augmented reality (AR) systems based on hyperaccuracy models (HA3D) in identifying tumours and intrarenal structures during transperitoneal RAPN (AR-RAPN), compared with standard ultrasound (US). DESIGN, SETTING, AND PARTICIPANTS A retrospective study was conducted, including 91 patients who underwent RAPN for complex renal tumours, 48 with 3D AR guidance and 43 with 2D US guidance, from July 2017 to May 2019. SURGICAL PROCEDURE In patients who underwent 3D AR-RAPN, virtual image overlapping guided the surgeon during resection and suture phases. In the 2D US group, interventions were driven by US only. MEASUREMENTS Patient characteristics were tested using the Fisher's exact test for categorical variables and the Mann-Whitney test for continuous ones. Intraoperative, postoperative, and surgical outcomes were collected. All results for continuous variables were expressed as medians (range), and frequencies and proportions were reported as percentages. RESULTS AND LIMITATIONS The use of 3D AR guidance makes it possible to correctly identify the lesion and intraparenchymal structures with a more accurate 3D perception of the location and the nature of the different structures relative to the standard 2D US guidance. This translates to a lower rate of global ischaemia (45.8% in the 3D group vs 69.7% in the US group; p = 0.03), higher rate of enucleation (62.5% vs 37.5% in the 3D and US groups, respectively; p = 0.02), and lower rate of collecting system violation (10.4% vs 45.5%; p = 0.003). Postoperatively, 3D AR guidance use correlates to a low risk of surgery-related complications in 3D AR groups and a lower drop in estimated renal plasma flow at renal scan at 3 mo of follow-up (-12.38 in the 3D group vs -18.14 in the US group; p = 0.01). The main limitations of this study are short follow-up time and small sample size. CONCLUSIONS HA3D models that overlap in vivo anatomy during AR-RAPN for complex tumours can be useful for identifying the lesion and intraparenchymal structures that are difficult to visualise with US only. This translates to a potential improvement in the quality of the resection phase and a reduction in postoperative complications, with better functional recovery. PATIENT SUMMARY Based on our findings, three-dimensional augmented reality robot-assisted partial nephrectomy seems to help surgeons in the management of complex renal tumours, with potential early postoperative benefits.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Andrea Bellin
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Pietro Piazzolla
- Department of Management and Production Engineer, Polytechnic University of Turin, Italy
| | | | - Ivano Morra
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alex Mottrie
- Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Robotic Surgery Institute Academy, Melle, Belgium
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Abaza R, Gerhard RS, Martinez O. Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience. World J Urol 2019; 38:1087-1092. [DOI: 10.1007/s00345-019-02935-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
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McLean A, Mukherjee A, Phukan C, Veeratterapillay R, Soomro N, Somani B, Rai BP. Trans-peritoneal vs. retroperitoneal robotic assisted partial nephrectomy in posterior renal tumours: need for a risk-stratified patient individualised approach. A systematic review and meta-analysis. J Robot Surg 2019; 14:1-9. [DOI: 10.1007/s11701-019-00973-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/01/2019] [Indexed: 12/23/2022]
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Lombardo R, Martos R, Ribal MJ, Alcaraz A, Tubaro A, De Nunzio C. Retroperitoneoscopy in urology: a systematic review. MINERVA UROL NEFROL 2019; 71:9-16. [PMID: 30607927 DOI: 10.23736/s0393-2249.18.03235-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In the past years, several authors have focused on the role of retroperitoneoscopic laparoscopy in the treatment of urological diseases. Aim of our study is to systematically review the available literature on retro-peritoneoscopic laparoscopy in urology. EVIDENCE ACQUISITION A systematic review of the literature using the Medline, Scopus, and Web of Science databases for relevant articles published until June 2018 was performed using both the Medical Subjects Heading and free test protocols. The MeSH search was conducted by combining the following terms: "retroperitoneoscopy," "posterior laparoscopy," "retroperitoneoscopic." Only randomized clinical trials were included in the analysis. Risk of bias assessment and forest plots were used to summarize data. EVIDENCE SYNTHESIS Nine RCTs on simple, partial and radical nephrectomy, pyeloplasty, ureterolithotomy and nephrolithotomy comparing RP to other techniques were included in the analysis. Retroperitoneoscopic approach in simple or radical nephrectomy is to be considered a valid alternative to transperitoneal laparoscopic approach. Outcomes and safety profiles (6-8% conversion rate) are similar and the approach depends on surgeon's preferences. Randomized studies analyzing retroperitoneoscopic pyeloplasty showed better results in terms of perioperative morbidity (tramadol use: 147 vs. 179 mg, P=0.002) and return to normal activities when compared to either anterior laparoscopic either to minimally invasive open approach. Two randomized studies have confirmed the efficacy (stone-free rate: 94%) and safety (no Clavien-Dindo >II complications) of ureterolithotomy and nephrolithotomy (stone-free rate: 95%) in the management of large renal and ureteral stones. CONCLUSIONS Retroperitoneoscopic approach in urological diseases is a valid alternative to the anterior approach. Evidence suggest lower morbidity for the retroperitoneoscopic approach however technical complexity may limit its widespread.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Raul Martos
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | - Maria J Ribal
- Department of Urology, Hospital Clínic, Barcelona, Spain
| | | | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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