Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France.
Department of Urology, chu Poitiers, Poitiers, France.
J Robot Surg. 2023 Dec;17(6):2563-2574. doi: 10.1007/s11701-023-01685-w. Epub 2023 Aug 18.
RAPN can be carried out via a transperitoneal or retroperitoneal approach. The choice between the two approaches is open to debate and usually based on surgeon preference. The perioperative outcomes of transperitoneal robot-assisted partial nephrectomy versus retroperitoneal robot-assisted partial nephrectomy were compared. A systematic review of the literature was performed up to May 2020, using PubMed, Cochrane, Scopus and Ovid databases. Articles were selected according to a search strategy based on PRISMA criteria. Only studies comparing TRAPN with RRAPN were eligible for inclusion. Eleven studies were included in the quantitative synthesis. Baseline demographics (age, BMI, ASA, tumour size, and RENAL nephrometry score), intraoperative data (operative time, estimated blood loss, and warm ischaemia time) and postoperative outcomes (major complications according to Clavien-Dindo, length of hospital stay (LOS) and positive surgical margin rate) were recorded. A total of 3139 patients were included (2052 TRAPN vs. 1087 RRAPN). There was no significant difference in demographic variables (age, BMI), tumour size (p = 0.06) nor the nephrometry score (p = 0.20) between the two groups. Operative time (p = 0.02), estimated blood loss (p < 0.00001) and LOS (p < 0.00001) were significantly lower in the RRAPN group. No differences were found in major postoperative complications (Clavien-Dindo > 3; p = 0.37), warm ischaemia time (p = 0.37) or positive surgical margins (p = 0.13). Future researchers must attempt to achieve adequately powered, expertise based, multi-surgeon and multi-centric studies comparing TRAPN and RRAPN. RRAPN gives similar outcomes to TRAPN. RRAPN is associated with reduced operative time and LOS. Ideally, surgeons should be familiar and competent in both RAPN approaches and adopt a risk-stratified and patient-centred individualised approach, dependent on the tumour and patient characteristics. RAPN is feasible via two approaches. The retroperitoneal approach seems to be associated with a shorter operation time and hospital stay.
RAPN 可通过经腹腔或后腹腔途径进行。两种方法的选择存在争议，通常基于外科医生的偏好。比较了经腹腔机器人辅助部分肾切除术与后腹腔机器人辅助部分肾切除术的围手术期结果。对截至 2020 年 5 月的文献进行了系统回顾，使用了 PubMed、Cochrane、Scopus 和 Ovid 数据库。根据基于 PRISMA 标准的搜索策略选择文章。只有比较 TRAPN 与 RRAPN 的研究才有资格入选。定量综合分析纳入了 11 项研究。记录了基线人口统计学特征（年龄、BMI、ASA、肿瘤大小和 RENAL 肾测量评分）、术中数据（手术时间、估计失血量和热缺血时间）和术后结果（根据 Clavien-Dindo 分级的主要并发症、住院时间 (LOS) 和阳性手术切缘率）。共纳入 3139 例患者（2052 例 TRAPN 与 1087 例 RRAPN）。两组间的人口统计学变量（年龄、BMI）、肿瘤大小（p=0.06）和肾测量评分（p=0.20）均无显著差异。RRAPN 组的手术时间（p=0.02）、估计失血量（p<0.00001）和 LOS（p<0.00001）明显较低。两组间主要术后并发症（Clavien-Dindo>3；p=0.37）、热缺血时间（p=0.37）或阳性手术切缘率（p=0.13）无差异。未来的研究人员必须尝试进行足够有力的、基于专业知识的、多外科医生和多中心的 TRAPN 和 RRAPN 比较研究。RRAPN 与 TRAPN 具有相似的结果。RRAPN 与手术时间和 LOS 缩短相关。理想情况下，外科医生应熟悉并精通两种 RAPN 方法，并根据肿瘤和患者特征采用风险分层和以患者为中心的个体化方法。RAPN 可通过两种途径进行。后腹腔途径似乎与手术时间更短和住院时间更短有关。
