Evaluation of the Clinical Use of Robot-Assisted Retroperitoneal Laparoscopy and Preoperative RENAL Scoring for Nephron Sparing Surgery in Renal Tumor Patients

The present study aims to compare the operative outcomes following the use of robot-assisted retroperitoneal partial nephrectomy (RARPN) with radius, exophytic/endophytic, nearness to sinus, anterior/posterior, and location (RENAL) scoring or laparoscopic retroperitoneal partial nephrectomy (LRPN) for the treatment of renal tumors. Eighty-three nephron-sparing surgery (NSS) procedures performed between January 2013 and December 2015 were reviewed. The study set consisted of 26 robot-assisted retroperitoneal laparoscopes, of which 3 were high risk (RENAL score ≥10), 11 were medium risk (RENAL score ≥7 < 9), and 12 were low risk (RENAL score <7) and 57 laparoscopic retroperitoneal partial nephrectomy procedures (7 high, 22 medium, and 28 low risk). All surgeries were successful in the absence of conversion or transfusion. Operative times were 96.0 ± 16.9 and 110.0 ± 19.4 min for RARPN and LRPN, respectively (P < 0.05). Warm ischemia times (WITs) were 17.6 ± 3.1 and 22.8 ± 3.5 min, respectively (P < 0.05). Estimated blood losses (EBLs) were 45 ± 15 and 97 ± 25 mL, respectively (P < 0.05). No statistical significance was found in duration of drainage, intestinal recovery time, hospital stay, serum creatinine, and perioperative complications (P > 0.05). RARPN affords significant advantages in outcomes of WIT, EBL, and recovery time over conventional LRPN owing to an increased accuracy in excision and suturing. Patients bearing high-risk renal tumors (RENAL score ≥10) are suitable candidates for RARPN.