Perioperative outcomes between laparoscopic versus open versus robotic partial nephrectomy: Current Review

Background: Surgical treatment of small renal tumours remain gold-standard for individuals who are suitable candidates. Over the last decade, minimally invasive surgery has provided significant advancements within the field of urological surgery. However, there is still a debate on which surgical modality is superior. This study aims to review the current literature on perioperative outcomes between laparoscopic (LPN), open (OPN) and robotic-assisted partial nephrectomy (RPN) using the standardised system, Clavien-Dindo Classification (CDC). Methods: A literature search was performed on Cochrane, Embase and PubMed databases. Articles between January 2016 and December 2021 were included. Perioperative outcomes investigated include estimated blood loss (EBL), operating time (OT), conversion rate (CR), warm ischaemia time (WIT), positive surgical margin (PSM) and postoperative complications using CDC. Relevant pieces of literatures were analysed and data were extracted. Results: This study included 12 studies, with a total of 3908 patients. (LPN = 1120, OPN = 1206 and RPN = 1580). LPN demonstrated a lower overall EBL (p = 0.004). There was no significant difference between OT (p = 0.291), CR (p = 0.200), WIT (p = 0.760), PSM (p = 0.549), CDC I (p = 0.556), CDC II (p = 0.779) and CDC > III (p = 0.663) of the three surgical approaches. Conclusion: Compared with OPN and RPN, LPN demonstrated a lower EBL. All other perioperative outcomes demonstrated similar results between the three treatment modalities. Future large-scale, prospective, randomised studies is necessary to draw a definitive conclusion from this analysis.