Impact of robotic assistance on the use and the outcomes of nephron-sparing surgery: A single center experience

Introduction. - The aim of this study was to assess the impact of the acquisition of a Da Vinci (R) robot on the use and outcomes of partial nephrectomy (PN). Patients and methods. - It was a single center retrospective study including 280 patients who underwent PN from January 2006 to May 2013. The number of PN, tumors and patients' characteristics and perioperative outcomes have been assessed over 3 periods defined according to the main surgical approach: 2006-2008 (open PN), 2008-2010 (laparoscopic PN) and 2010-2013 (robotic PN). Results. - Over the study period, the surgical approach has changed significantly in favor of minimally-invasive surgery and especially robotic approach. The PN/nephrectomy rate has also evolved to a higher proportion of PN over radical nephrectomy (P=0.002). No significant difference was noted between the three periods in terms of tumor size but there was a higher rate of highly complex tumors (RENAL score > 10) during the last period (10.7%; 18.6% and 33.2%; P=0.04). Warm ischemia time increased from 2006-2008 to 2008-2010 (26 vs. 23 minutes) but decreased thereafter during the robotic era (14.5 minutes; P< 0.001). Regarding postoperative outcomes, the only change was a decreased length of stay over time (P=0.003). Conclusion. - In this single center series, the robotic approach was associated with a spread of PN and with an improvement of nephron-sparing surgery outcomes. (C) 2016 Elsevier Masson SAS. All rights reserved.