Comparison Of The Efficacy Of Robot-assisted Laparoscopic And Laparoscopic Partial Nephrectomy For Central Renal Tumor Through Retroperitoneal Approach

Objective:To analyze and compare the clinical efficacy of two surgical methods through retroperitoneal approach,namely robot-assisted laparoscopic partial nephrectomy and traditional laparoscopic partial nephrectomy,in the treatment of central renal tumor less than 5mm from the collection system of the kidney.Materials and Methods:This article collected data on patients with renal tumors who have been treated with Departments of Urinary Surgery at the First Affiliated Hospital of Nanchang University from January 2016 to June 2018.According to the inclusion criteria and exclusion criteria,60 patients with central renal tumor who underwent nephron-sparing surgery were enrolled,including 35 patients who underwent robot-assisted laparoscopic partial nephrectomy and 25 patients who underwent laparoscopic partial nephrectomy.All patients underwent retroperitoneal approach.The preoperative basic data,perioperative indexes,postoperative tumor results,postoperative renal function changes and follow-up were retrospectively analyzed and compared between the two groups.Results:A total of 60 patients in the RALPN and LPN groups were successfully performed without transit radical resection or open surgery.The differences in operative time(182.8±25.2 min vs 157±47.7 min),warm ischemia time(25.6±5.5 min vs 22.8±4.8 min),the value of postoperative eGFR changes(-19.4±12.0 ml/min/1.73m2 vs-12.3±0.4 ml/min/1.73m2),and percentage of postoperative eGFR changes(-20.4±11.6%vs-13.9±9.7%)were statistically significant(P<0.05).The intraoperative estimated blood loss,intestinal ventilation time,drainage tube removal time,postoperative hospital stay,intraoperative complications,Clavien-Dindo classification of postoperative complications,transfusion rate,tumor pathological type,and Fuhrman grade were no significant differences(P>0.05).The median follow-up time of the two groups was 11 months,and no local recurrence or distant metastasis occurred.Conclusions:Robot-assisted laparoscopic partial nephrectomy is safe and effective in the treatment of central renal tumors.It has a better clinical efficacy than traditional laparoscopic group.There were statistically significant differences in operative time,warm ischemia time,postoperative eGFR values and percentages.The intraoperative estimates of blood loss,intestinal ventilation time,postoperative hospital stay,perioperative complications,postoperative tumor outcomes,recurrence and survival rates for short-term follow-up were similar.The high-definition 3D view of the robot and the flexible robotic arm have a great advantage in the removal of deep central tumors,especially on hemostasis and suture wounds.It also shortens the warm ischemia time and retains more renal function.