Robotic versus Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis of Randomised Trials.

Abstract

Introduction: The objective of this article is to compare outcomes of robotic-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN) for surgical management of renal tumours by performing a systematic review.

Materials and methods: Prospective randomised controlled trials comparing robotic to laparoscopic partial nephrectomy were included in this analysis. No date or language restriction was imposed. Studies on paediatric patients (<16 years old) were excluded. No specific outcomes were required for inclusion in the analysis. The authors independently extracted data and assessed the risk of bias using the risk of bias tool (RoB 1). Meta-analysis was performed using ReviewManager (RevMan) Software (Cochrane Collaboration, London, United Kingdom).

Results: Two prospective randomised controlled trials involving 190 participants were included. A comparative analysis of 190 patients undergoing partial nephrectomy showed no significant difference in overall complication rates. However, RAPN was associated with a reduced risk of minor complications (Clavien-Dindo grade 1-2). Operatively, LPN demonstrated a marginally shorter duration; whereas, RAPN showed a slight advantage in warm ischemia time. Regarding renal function, RAPN resulted in a less pronounced increase in serum creatinine levels six months postoperatively. In contrast, changes in estimated glomerular filtration rate did not significantly differ between the groups. Length of hospital stay and positive surgical margin rates were comparable between approaches.

Conclusion: There is limited low-quality evidence in small-scale trials that may indicate robotic partial nephrectomy is comparable to laparoscopic partial nephrectomy. RAPN has lower minor complication rates, with potential advantages in warm ischemia time and complication rates.