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Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis

Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis
Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis
Contex: centres worldwide have been performing partial nephrectomies laparoscopically for greater than a decade. With the increasing use of robotics, many centres have reported their early experiences using it for nephron-sparing surgery.Objective: to review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN).Evidence acquisition: an online systematic review of the literature according to Cochrane guidelines was conducted from 2000 to 2012 including studies comparing RPN and LPN. All studies comparing RPN with LPN were included. The outcome measures were the patient demographics, tumour size, operating time, warm ischaemic time, blood loss, transfusion rates, length of hospital stay, conversion rates, and complications. A meta-analysis of the results was conducted. For continuous data, a Mantel-Haenszel chi-square test was used; for dichotomous data, an inverse variance was used. Each was expressed as a risk ratio with a 95% confidence interval p < 0.05 considered significant.Evidence synthesis: a total of 717 patients were included, 313 patients in the robotic group and 404 patients in the laparoscopic group (seven studies). There was no significant difference between the two groups in any of the demographic parameters except for age (age: p = 0.006; sex: p = 0.54; laterality: p = 0.05; tumour size: p = 0.62, tumour location: p = 57; or confirmed malignant final pathology: p = 0.79). There was no difference between the two groups regarding operative times (p = 0.58), estimated blood loss (p = 0.76), or conversion rates (p = 0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p = 0.0008). There was no difference regarding postoperative length of hospital stay (p = 0.37), complications (p = 0.86), or positive margins (p = 0.93).Conclusions: in early experience, RPN appears to be a feasible and safe alternative to its laparoscopic counterpart with decreased warm ischaemia times noted.
Humans, Laparoscopy, Nephrectomy, Robotics, Comparative Study, Journal Article, Meta-Analysis, Review
0302-2838
1023-1033
Aboumarzouk, Omar M.
3c7e2433-638d-4378-9931-902fdc68acce
Stein, Robert J.
4590c88a-5a22-445f-8e7e-65204279cb11
Eyraud, Remi
6ad038aa-e962-4f3f-943f-a31589eb9a96
Haber, Georges-Pascal
4e792ea4-1941-4efb-a212-8915d5b3c618
Chlosta, Piotr L.
f15638f2-4870-42e8-a972-a179a7573cb5
Kaouk, Jihad H.
bc0e922a-b91e-4cf1-94a2-53f941aeae5b
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Aboumarzouk, Omar M.
3c7e2433-638d-4378-9931-902fdc68acce
Stein, Robert J.
4590c88a-5a22-445f-8e7e-65204279cb11
Eyraud, Remi
6ad038aa-e962-4f3f-943f-a31589eb9a96
Haber, Georges-Pascal
4e792ea4-1941-4efb-a212-8915d5b3c618
Chlosta, Piotr L.
f15638f2-4870-42e8-a972-a179a7573cb5
Kaouk, Jihad H.
bc0e922a-b91e-4cf1-94a2-53f941aeae5b
Somani, Bhaskar K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Aboumarzouk, Omar M., Stein, Robert J., Eyraud, Remi, Haber, Georges-Pascal, Chlosta, Piotr L., Kaouk, Jihad H. and Somani, Bhaskar K. (2012) Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. European Urology, 62 (6), 1023-1033. (doi:10.1016/j.eururo.2012.06.038).

Record type: Review

Abstract

Contex: centres worldwide have been performing partial nephrectomies laparoscopically for greater than a decade. With the increasing use of robotics, many centres have reported their early experiences using it for nephron-sparing surgery.Objective: to review published literature comparing robotic partial nephrectomy (RPN) with laparoscopic partial nephrectomy (LPN).Evidence acquisition: an online systematic review of the literature according to Cochrane guidelines was conducted from 2000 to 2012 including studies comparing RPN and LPN. All studies comparing RPN with LPN were included. The outcome measures were the patient demographics, tumour size, operating time, warm ischaemic time, blood loss, transfusion rates, length of hospital stay, conversion rates, and complications. A meta-analysis of the results was conducted. For continuous data, a Mantel-Haenszel chi-square test was used; for dichotomous data, an inverse variance was used. Each was expressed as a risk ratio with a 95% confidence interval p < 0.05 considered significant.Evidence synthesis: a total of 717 patients were included, 313 patients in the robotic group and 404 patients in the laparoscopic group (seven studies). There was no significant difference between the two groups in any of the demographic parameters except for age (age: p = 0.006; sex: p = 0.54; laterality: p = 0.05; tumour size: p = 0.62, tumour location: p = 57; or confirmed malignant final pathology: p = 0.79). There was no difference between the two groups regarding operative times (p = 0.58), estimated blood loss (p = 0.76), or conversion rates (p = 0.84). The RPN group had significantly less warm ischaemic time than the LPN group (p = 0.0008). There was no difference regarding postoperative length of hospital stay (p = 0.37), complications (p = 0.86), or positive margins (p = 0.93).Conclusions: in early experience, RPN appears to be a feasible and safe alternative to its laparoscopic counterpart with decreased warm ischaemia times noted.

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More information

Accepted/In Press date: 19 June 2012
e-pub ahead of print date: 29 June 2012
Published date: December 2012
Additional Information: Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords: Humans, Laparoscopy, Nephrectomy, Robotics, Comparative Study, Journal Article, Meta-Analysis, Review

Identifiers

Local EPrints ID: 419466
URI: https://eprints.soton.ac.uk/id/eprint/419466
ISSN: 0302-2838
PURE UUID: 4731c2d2-4925-461a-b071-c07387f0f269

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Date deposited: 12 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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