Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis

• Robotic partial nephrectomy can be performed through transperitoneal and retroperitoneal approach.
• Transperitoneal approach has similar complications, conversions, warm ischemia time, blood loss, and surgical margins compared with retroperitoneal approach.
• Retroperitoneal approach has marginally shorter operative time compared with transperitoneal approach.

PurposeTo compare the perioperative outcomes of the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN).MethodsA literature search of MEDLINE, EMBASE, SCOPUS and the Cochrane Library was performed to identify relevant studies up to March 2016. All studies with enough data comparing TP-RAPN with RP-RAPN were included. Outcomes of interest were complication, conversion, operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and positive surgical margin (PSM). Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was assessed by funnel plots.ResultsFour studies with the total number of 449 patients assessing TP-RAPN (n = 229) versus RP-RAPN (n = 220) were included. There was no significant difference between the two groups in any of demographic variables. There were also no significant differences between TP-RAPN and RP-RAPN groups regarding tumor size, tumor laterality, R.E.N.A.L. nephrometry score, and tumor pathology. There was marginally significant difference between the two groups regarding OT (p = 0.05, WMD: 28.03; 95% CI, 0.41–55.65). No significant differences were found regarding complication, conversion, WIT, EBL, and PSM. No obvious publication bias was observed.ConclusionsThe present meta-analysis suggests that RP-RAPN appears to be equally safe and efficacious in terms of complication, conversion, WIT, EBL and PSM compared with TP-RAPN. In addition, RP-RAPN has marginally significant advantage of shorter OT. Randomized controlled trials and high-quality observational cohort studies with large sample size and long-term follow-up are needed to update our findings.