Application Of Robotic-assisted Laparoscopic Partial Nephrectomy Of Renal Tumor

Objective:Compare Robotic Assisted Partial Nephrectomy(Robotic Assisted Partial Nephrectomy,RAPN)and Laparoscopic Partial Nephrectomy(LPN)in the treatment of renal tumor,and analyze the clinical application value of RAPN.Method:Clinical data of 198 patients with renal tumor who underwent partial nephrect-omy in our center from July 2019 to December 2021 were collected,and they were divided into RAPN group(70 cases)and LPN group(128 cases)according to surgical methods.The differences between the two groups in operative time,warm ischemia time,intraoperative blood loss,transferring other surgical procedures rate,perioperative blood transfusion rate,positive margin rate,incidence of postoperative complications,drainage tube indwelling time,postoperative hospital stay,total hospitalization cost,and postoperative 3 months creatinine elevations were analyzed and compared.According to RENAL score,the two groups were divided into normal group(RENAL score < 7)and complex group(RENAL score ≥7)for subgroup analysis and comparison.According to MAP score,the two groups were divided into normal group(MAP score 0 ~ 3)and high group(MAP score 4 ~ 6),for subgroup analysis and comparison.Results:Results of overall comparison between RAPN group and LPN group: A total of70 patients were enrolled in RAPN group and 128 patients in LPN group.There was no statistical difference in general preoperative data between the two groups(P >0.05).There was no significant difference between the two groups in intraoperative blood loss,transferring other surgical procedures rate,perioperative blood transfusion rate,positive margin rate,incidence of postoperative complications,drainage tube indwelling time,postoperative hospital stay and postoperative 3 months creatinine elevations(P > 0.05).Compared with LPN group,there were longer operation time,higher total hospitalization cost,but shorter warm ischemia time in RAPN group.Results of normal RENAL score group: 29 cases in RAPN group and 66 cases in LPN group were included.Compared with LPN group,there were longer operation time,higher total hospitalization cost,but shorter warm ischemia time in RAPN group.Results of complex RENAL score group: 41 cases in RAPN group and 62 cases in LPN group were included.Compared with LPN group,there were shorter warm ischemia time,drainage tube indwelling time,postoperative hospital stay,less intraoperative blood loss,lower incidence of postoperative complications,but higher total hospitalization cost in RAPN group.Results of normal MAP score group: 42 cases in RAPN group and 88 cases in LPN group were included.Compared with LPN group,there were shorter warm ischemia time,but higher total hospitalization cost in RAPN group.Results of high MAP score group: 28 cases in RAPN group and 40 cases in LPN group were included.Compared with LPN group,there were shorter operation time,warm ischemia time,drainage tube indwelling time and postoperative hospital stay,less intraoperative blood loss,but higher total hospitalization cost in RAPN group.Conclusion:Robotic laparoscopic partial nephrectomy(RAPN)is safe and effective in the treatment of renal tumors,and can shorten the warm ischemia time compared with traditional laparoscopy.RENAL score and MAP score can be used to assess the complexity of the tumor and the presence of perirenal fatty adhesions(APF).RAPN has certain advantages in patients with RENAL score > 7 and high MAP score(4-5),and can provide better perioperative results.RAPN is a better choice than traditional LPN.