Comparison of Short-Term Functional, Oncological, and Perioperative Outcomes Between Laparoscopic and Robotic Partial Nephrectomy Beyond the Learning Curve

Purpose: To compare the short-term outcomes of robot-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) when performed by highly experienced surgeons. Methods: A prospective multicenter study was conducted, including the 50 last patients having undergone LPN and RPN for T1-T2 renal tumors in two institutions between 2013 and 2016, performed by two different surgeons with an experience of over 200 procedures each in LPN and RPN, respectively, at the beginning of the study. Perioperative parameters and functional and oncological outcomes were collected and compared between the LPN and RPN groups. Results: The laparoscopic approach was associated with a longer warm ischemia time (15.7 versus 23 minutes; P<.001) and hospital stay (3.6 versus 4.6 days; P=.01). Conversely, estimated blood loss was significantly higher in the RPN group (381mL versus 215mL; P<.001), but transfusion rates were similar between the two groups (8% versus 6%; P=.33). In the RPN group, three patients (6%) required conversion to open partial nephrectomy and three patients (6%) required a conversion to radical nephrectomy (RN), while no conversion was needed in the LPN group. There were no differences in terms of perioperative complications, and change in renal function was comparable in the two groups postoperatively. Positive surgical margin rates were similar in the RPN and LPN groups (2% versus 6%; P=.36). After a median follow-up of 19 and 14 months in the RPN and LPN groups, respectively (P=.38), recurrence-free survivals did not differ significantly (P=.94). Conclusion: In this series, perioperative and short-term oncological and functional outcomes appeared broadly comparable between RPN and LPN when performed by highly experienced surgeons.