Robot-assisted surgery is practiced more and more frequently in urology. Besides its place in prostatectomy for cancer, it also concerns partial nephrectomy (NP), in the treatment of renal tumors. The objective of this review is to compare the robot-assisted approach with laparoscopic or open approaches in partial nephrectomy in terms of functional or oncological outcomes and per- and postoperative complications.
A systematic review of the literature published from 2009 was carried out on PubMed. Clinical studies or meta-analyzes comparing robot-assisted surgery versus laparoscopic or open surgery in the NP domain were used.
The clinical data presented in this review of the literature are based mainly on meta-analyzes of comparative studies. Patients operated with robotic assistance (NPAR) had significantly fewer postoperative complications than patients operated by open (RR 0.61; P=0.0002) or laparoscopic surgery (RR 0.84; P=0.007). Positive margins, at equivalent pathological stages, are comparable to the open and appear to be lower than the laparoscopic surgery (RR 0.53; P<0.001). After NP, the change in postoperative glomerular filtration rate (GFR) appears to be identical between the 3 pathways. Hot ischemia time is significantly shorter for NPAR compared to NPL. Finally, the estimated blood loss and length of stay are less severe in patients operated by NPAR compared to those operated by open surgery.
Robot-assisted surgery offers the same oncological results (in the short and medium term) and appears to improve functional outcomes and morbidity. However, these findings need to be carefully analyzed, due to the low level of evidence from the studies presented and included in the meta-analyzes, and the lack of randomized clinical studies.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2018 Oct 02 [Epub ahead of print]
G Poinas, J-A Long, X Rébillard, J-L Descotes
Clinique Beau Soleil-EA2415, 119, avenue Lodève, 34070 Montpellier, France. Electronic address: ., Centre hospitalier universitaire de Grenoble, 38700 Grenoble, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France., Clinique Beau Soleil-EA2415, 119, avenue Lodève, 34070 Montpellier, France.