#1443

A Comparative Analysis of Robotic vs Laparoscopic Partial Nephrectomy for a Complex Renal Mass (R.E.N.A.L. Score ≥ 10); Single surgeon study

S. Miran^1,2, A. Hong³, H. Zargar^3,4,5

¹Monash University, Department of Surgery, Melbourne, Australia
²Alfred Health, Department of Urology, Melbourne, Australia
³University of Melbourne, Department of Surgery, Melbourne, Australia
⁴Western Health, Department of Urology, Melbourne, Australia
⁵Western Clinical Trials, Department of Urology, Melbourne, Australia

Introduction:

This study retrospectively reviews prospectively collected data to compare perioperative and postoperative outcomes in patients with a complex renal mass (R.E.N.A.L. score≥10) undergoing robotic partial nephrectomy (RPN) or Laparoscopic partial nephrectomy (LPN). In addition, we asses achievement of the defined trifecta and “optimal outcome”.

Material and methods:

From 2017 to 2024, a total of 56 patients underwent partial nephrectomy performed by a single surgeon (39 RPN, 17 LPN). Trifecta was defined as achieving three criteria: warm ischemia time greater than 25 minutes, negative surgical margins, and absence of postoperative complications. “Optimal outcome” was defined as achieving the trifecta in addition to a short-term (3-month) estimated glomerular filtration rate (eGFR) preservation of greater than 90%. Postoperative complications were classified according to the Clavien-Dindo classification. Statistical analyses were conducted using GraphPad Prism (version 10.4).

Results:

Of the 56 patients, 39 underwent RPN, and 17 underwent LPN. The groups had comparable median age (65 vs. 58 years), tumor size (median 43.00 mm vs. 60.00 mm), R.E.N.A.L. scores (median 10.0 vs. 10.0). WIT was 0 minutes in 11 RPN and 6 LPN cases, with no significant difference in mean WIT (13.74 vs. 12.00 minutes, p = 0.6506). Negative surgical margin rates (86.84% vs. 92.31%, p >0.9999), complication rates (6.25% vs. 9.09%, p = 0.6463), and eGFR preservation > 90% (71.05% vs. 66.67%, p = 0.7510) were comparable between groups. The rates of achieving trifecta (69.23% RPN vs. 76.47% LPN, p=0.7510) and optimal outcome (55.00% RPN vs. 52.94% LPN, p >0.9999) showed no significant difference between the groups.