Transperitoneal and Retroperitoneal Approach in Robotic-Assisted Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis
LIAO Hai1, YU Leilei2, CHEN Fubing1, YANG Yong1, DAI Hang1, ZHANG Senlin1, ZHANG Wensen1
1Department of Urology, the First People's Hospital of Suining, Suining 629000, China; 2Department of Endocrinology, the First People's Hospital of Suining
Abstract:Objective: To compare the effect of retroperitoneal and transperitoneal approach for robot-assisted laparoscopic partial nephrectomy. Methods: The researchers searched CBM, CNKI, Wanfang database, PubMed, EMBASE and Cochrane Library by computer. According to the inclusion and exclusion criteria, we screened out the qualified literature, and extracted the relevant data. Finally, Revman 5.3 and Stata 12.0 software was adopted for analysis. Results: This meta-analysis included 11 non-randomized controlled studies. A total of 2542 patients were included in the final analysis. Our results showed that the retroperitoneal approach group had shorter operation time (MD = 11.68, 95% CI: 5.69-17.67, P = 0.01), less blood loss (MD = 23.52, 95% CI: 12.85-34.19, P < 0.01) and shorter postoperative intestinal discharge time (MD = 2.33, 95% CI: 0.45-4.20, P = 0.01). The warm ischemia time (MD = -0.00, 95% CI: -0.25-0.25, P = 0.98), postoperative complications (OR = 1.29, 95% CI: 0.93-1.74, P = 0.13), and positive surgical margins (OR = 1.41, 95% CI: 0.69-2.90, P = 0.35) showed no significant difference between the two groups. Conclusion: For some patients, especially those with posterior tumor or history of abdominal surgery, retroperitoneal approach group can shorten the operation time and postoperative intestinal discharge time, and reduce the blood loss. There is no significant difference between the two groups in terms of the warm ischemia time, postoperative complications and positive surgical margins.
[1] CAMPBELL S, UZZO RG, ALLAF ME, et al.Renal mass and localized renal cancer: AUA guideline. J Urol, 2017,198(3):520-529.
[2] LJUNGBERG B, ALBIGES L, ABU-GHANEM YA, et al.European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol, 2019,75(5):799-810.
[3] AN JY, BALL MW, GORIN MA, et al.Partial vs radical nephrectomy for T1-T2 renal masses in the elderly: comparison of complications, renal function, and oncologic outcomes. Urology, 2017,100:151-157.
[4] KAOUK JH, KHALIFEH A, HILLYER S, et al.Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol, 2012,62(3):553-561.
[5] HU JC, TREAT E, FILSON CP, et al.Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. Eur Urol, 2014,66(3):542-549.
[6] MIYAKE H, HINATA N, IMAI S, et al.Partial nephrectomy for hilar tumors: comparison of conventional open and robot-assisted approaches. Int J Clin Oncol, 2015,20(4):808-813.
[7] VASDEV N, GIESSING M, ZENGINI H, et al.Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques. J Robot Surg, 2014,8(2):157-161.
[8] BUFFI NM, SAITA A, LUGHEZZANI G, et al.Robot-assisted Partial Nephrectomy for Complex (PADUA Score ≥10) Tumors: Techniques and Results from a Multicenter Experience at Four High-volume Centers. Eur Urol, 2020,77(1):95-100.
[9] 高宇,张旭.机器人肾部分切除术的应用现状和研究进展.微创泌尿外科杂志,2016,5(1):56-62.
[10] MOHER D, SHAMSEER L, CLARKE M, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015,4(1):1.
[11] 王昕凝,祖强,黄双,等.后腹腔镜、机器人腹腔镜、机器人后腹腔镜肾部分切除术的比较:单一术者经验.中国微创外科杂志,2018,18(10):874-877,898.
[12] 汤昊,张征宇,周文泉,等.经腹与腹膜后入路机器人辅助腹腔镜肾部分切除术治疗早期肾癌的比较.临床肿瘤学杂志,2015,20(12):1128-1131.
[13] 邰胜,周骏,施浩强,等.机器人辅助腹腔镜肾部分切除术不同手术入路的近期疗效分析.临床泌尿外科杂志,2019,34(1):18-21,26.
[14] 宋思吉,何鹏,陈志朋,等.机器人辅助经腹腔与经后腹腔入路肾部分切除术对照研究.临床泌尿外科杂志,2019,34(11):845-849.
[15] STROUP SP, HAMILTON ZA, MARSHALL MT, et al.Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes. World J Urol, 2017,35(11):1721-1728.
[16] MAURICE MJ, KAOUK JH, RAMIREZ D, et al.Robotic partial nephrectomy for posterior tumors through a retroperitoneal approach offers decreased length of stay compared with the transperitoneal approach: a Propensity-Matched analysis. J Endourol, 2017,31(2):158-162.
[17] LAVIANA AA, TAN H, HU JC, et al.Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy. Curr Opin Urol, 2018,28(2):108-114.
[18] KIM EH, LARSON JA, POTRETZKE AM, et al.Retroperitoneal Robot-Assisted partial nephrectomy for posterior renal masses is associated with earlier hospital discharge: a Single-Institution retrospective comparison. J Endourol, 2015,29(10):1137-1142.
[19] HUGHES-HALLETT A, PATKI P, PATEL N, et al.Robot-Assisted partial nephrectomy: a comparison of the transperitoneal and retroperitoneal approaches. J Endourol, 2013,27(7):869-874.
[20] CHOO SH, LEE SY, SUNG HH, et al.Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores. World J Urol, 2014,32(6):1523-1529.
[21] ARORA S, HEULITT G, MENON M, et al.Retroperitoneal vs transperitoneal robot-assisted partial nephrectomy: comparison in a multi-institutional setting. Urology, 2018,120: 131-137.
[22] WRIGHT JL, PORTER JR.Laparoscopic partial nephrectomy: comparison of transperitoneal and retroperitoneal approaches. J Urol, 2005,174(3):841-845.
[23] KIERAN K, MONTGOMERY JS, DAIGNAULT S, et al.Comparison of intraoperative parameters and perioperative complications of retroperitoneal and transperitoneal approaches to laparoscopic partial nephrectomy: support for a retroperitoneal approach in selected patients. J Endourol, 2007,21(7):754-759.
[24] VON RF, SCOVELL JM, AGRAWAL S, et al.Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy. BJU Int, 2017,119(4):598-604.
[25] MCALLISTER M, BHAYANI SB, ONG A, et al.Vena caval transection during retroperitoneoscopic nephrectomy: report of the complication and review of the literature. J Urol, 2004,172(1):183-185.
[26] REN T, LIU Y, ZHAO X, et al.Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One, 2014,9(3):e91978.
[27] HINATA N, SHIROKI R, TANABE K, et al.Robot-assisted partial nephrectomy versus standard laparoscopic partial nephrectomy for renal hilar tumor: A prospective multi-institutional study. Int J Urol, 2021,28(4):382-389.
[28] HARKE NN, DARR C, RADTKE JP, et al. Retroperitoneal versus transperitoneal robotic partial nephrectomy: a multicenter matched-pair analysis. Eur Urol Focus, 2020,S2405-4569(20):30254-30256.
[29] CAMPBELL SC, NOVICK AC.Surgical technique and morbidity of elective partial nephrectomy. Semin Urol Oncol, 1995,13(4):281-287.
[30] THOMPSON RH, LANE BR, LOHSE CM, et al.Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol, 2010,58(3):331-336.
[31] PORPIGLIA F, FIORI C, BERTOLO R, et al.Long-term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors. Eur Urol, 2012,62(1):130-135.
[32] MIR MC, PAVAN N, PAREKH DJ.Current paradigm for ischemia in kidney surgery. J Urol, 2016,195(6):1655-1663.
[33] DINDO D, DEMARTINES N, CLAVIEN PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004,240(2):205-213.
[34] MEARINI L, NUNZI E, VIANELLO A, et al.Margin and complication rates in clampless partial nephrectomy: a comparison of open, laparoscopic and robotic surgeries. J Robot Surg, 2016,10(2):135-144.