[Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: a single institution experience]. / Néphrectomie partielle robot-assistée versus néphrectomie partielle laparoscopique : expérience d'un centre français.

OBJECTIVE: To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in a single French institution. PATIENTS: Between February 2008 and April 2012, 98 patients underwent RAPN (n=54) or NPL (n=44) for a kidney tumor. Demographic data, perioperative and pathological outcomes were compared using Student's test and χ2 for continuous and categorical variables, respectively. RESULTS: Both groups were comparable for age, BMI, American Society of Anesthesiologists classification (ASA) and preoperative renal function (MDRD clearance). Tumor complexity was increased in the RAPN group (55.5 % vs. 29.5 % RENAL score≥2, P=0.05). There was no significant difference in terms of operative time (191 vs. 202 min, P=0.2), tumor size (35 vs. 30mm, P=0.1) or positive margins (2 vs. 5, P=0.14). However, there was a significant decrease in warm ischemia time (18 vs. 25.6 min, P=0.004) and hospital stay (5.1 vs. 6.9 days, P=0.003) for RAPN. Estimated blood loss was greater in the RAPN group (490 vs. 280mL, P=0.003), but the numbers of transfusions were similar (5 vs. 4 patients, P=0.96). Urinary tract was more frequently entered in the RAPN group (28 vs. 12, P=0.009). The complication rate was similar in both groups (28 % vs. 32 %, P=0.66). CONCLUSION: RAPN is feasible and reproducible. As in previous publications, our study confirms a potential benefit of RAPN concerning warm ischemia.

Predictive factors of hemorrhagic complications after partial nephrectomy.

OBJECTIVES: To identify the predictive factors of hemorrhagic complications (HC) in a contemporary cohort of patients who underwent partial nephrectomy (PN). MATERIALS AND METHODS: Records of 199 consecutive patients who underwent PN between 2008 and 2012 at our institution were retrospectively analyzed. HC was defined as a hematoma requiring transfusion, an arterio-veinous fistula, a false aneurysm or a post-operative decrease of hemoglobin >3 g/dl. Patients with or without HC were compared using Wilcoxon and Fisher exact tests for continuous and categorical variables, respectively. We performed a univariate and multivariate analysis with a logistic regression model using the occurrence of an HC as the dependent variable. RESULTS: 54% of the patients were male with a median age of 61 (22-86) years. Median BMI was 26 (18-47) kg/m(2). Surgery was done open, laparoscopically or with robotic assistance in 106, 54 and 39 cases, respectively. Global complication rate was 40% including 21.6% HC. There were more complex tumors (75.6% vs. 66.5%, p = 0.04) and median length of stay was increased (11 days compared to 7 days, p < 0.0001) in case of a HC. In univariate analysis, imperative indication (p = 0.08), RENAL score (p = 0.07), operating time (p = 0.07) and operative blood loss > 250 ml (p = 0.002) were statistically relevant. In multivariate analysis, only operative blood loss >250 ml was identified as a predictive factor of HC (p = 0.0007). CONCLUSION: Patients who underwent a procedure with estimated blood loss >250 ml should be carefully monitored in the postoperative course.