Prone retroperitoneal versus lateral retroperitoneal robotic assisted partial nephrectomy: a propensity score-matched comparison.

OBJECTIVE

To compare perioperative outcomes of retroperitoneal robot-assisted partial nephrectomy (rRAPN) performed in the prone (prRAPN) versus lateral (lrRAPN) position.

METHODS

We reviewed 167 patients with clinically localized (cT1–2) renal masses treated with rRAPN at a high-volume tertiary center (prRAPN, n = 87; lrRAPN, n = 80). To account for baseline differences, 1:1 propensity-score matching (PSM) was performed.

RESULTS

After matching, 58 patients were included per group with balanced baseline characteristics. prRAPN achieved shorter hilar access time (HAT: 5.3 vs. 12.0 min; P < 0.001), operation time (OT: 41.3 vs. 72.8 min; P < 0.001), warm ischemia time (WIT: 18.5 vs. 25.0 min; P = 0.012) and renorrhaphy time (RT: 9.0 vs. 13.5 min; P < 0.001), with lower estimated blood loss, and shorter postoperative length of stay than lrRAPN. 90-day cumulative complications, trifecta achievement, postoperative 3-day change in hemoglobin, postoperative 1-year change in eGFR and intraoperative cardiopulmonary parameters were similar. On multivariable analysis, prRAPN independently predicted shorter OT and WIT, whereas higher R.E.N.A.L. score predicted prolongation. Subgroup analyses showed that HAT was shorter across all subgroups, with potential greater intraoperative efficiency gains (shorter OT, WIT and RT) in patients with BMI < 28 kg/m2, R.E.N.A.L. < 10, and posterior tumors. Median follow-up was 20.4 months for prRAPN and 38.9 months for lrRAPN, with no difference in PFS and OS. Limitations include the retrospective, single-center design.

CONCLUSIONS

prRAPN was as safe as lrRAPN and improved intraoperative efficiency. Potential benefit appeared greater in non-obese patients and in low–intermediate complexity or posterior tumors, for whom prRAPN may be preferred.