Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Background Most comparisons between robot‐assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) indicate the superiority of RAPN, but the learning curve is often not considered. Methods All consecutive partial nephrectomies from the very first RAPN at a single tertiary referral cent...

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Published in:The international journal of medical robotics + computer assisted surgery 2021-02, Vol.17 (1), p.1-8
Main Authors: Zeuschner, Philip, Greguletz, Leonie, Meyer, Irmengard, Linxweiler, Johannes, Janssen, Martin, Wagenpfeil, Gudrun, Wagenpfeil, Stefan, Siemer, Stefan, Stöckle, Michael, Saar, Matthias
Format: Article
Language:English
Subjects:
CAS
Computer assisted surgery
Kidney cancer
Kidneys
Learning curves
Longitudinal studies
minimally invasive surgery
nephrectomy
partial robot‐assisted partial nephrectomy
Regression analysis
renal cell carcinoma
Robots
Subgroups
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Summary:Background Most comparisons between robot‐assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) indicate the superiority of RAPN, but the learning curve is often not considered. Methods All consecutive partial nephrectomies from the very first RAPN at a single tertiary referral centre (n = 818, 500 RAPN vs. 313 OPN) were retrospectively analyzed. Complications, success rates and surgical outcomes were compared. Inequalities between cohorts and the inherent learning curve were controlled by subgroup comparisons, regression analyses, and propensity score matching. Results Overall, RAPN had fewer complications, less blood loss, and shorter length of stay. However, an inherent learning curve caused higher complications for the first 4 years. Thereafter, perioperative outcomes clearly favoured RAPN, even for more complex tumours. Conclusions In one of the largest monocentric cohorts over more than 10 years, RAPN was found to be superior to OPN. However, not all advantages of RAPN are immediate because a learning curve must be passed.
ISSN:1478-5951
1478-596X
DOI:10.1002/rcs.2167