© 2008 THE AUTHORS 86 JOURNAL COMPILATION © 2 0 0 8 B J U I N T E R N A T I O N A L | 1 0 2 , 8 6 – 9 2 | doi:10.1111/j.1464-410X.2008.07580.x 2008 The Authors Original Article COMPARISON OF ROBOTIC AND LAPAROSCOPIC PARTIAL NEPHRECTOMY ARON ET AL. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre Monish Aron, Phillipe Koenig, Jihad H. Kaouk, Mike M. Nguyen, Mihir M. Desai and Inderbir S. Gill Center for Laparoscopic and Robotic Urology, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Accepted for publication 5 December 2007 conventional unclamping). Operative measures evaluated included operative time, estimated blood loss, warm ischaemia time (WIT), and number of ports used. Outcomes measured included serum creatinine and estimated glomerular filtration rate before and after surgery, length of hospital stay, transfusion rate, operative and 30-day complication rate, and surgical margin status. RESULTS Overall there were no differences in perioperative variables (WIT, estimated blood loss, surgery time, length of stay) between the groups. Fewer ports were used during LPN. Renal functional outcomes, transfusion rate and complication rates were comparable. Two RPN cases required conversion to standard LPN. A subset analysis of six patients in each group who had early unclamping showed a 7-min shorter WIT with LPN (14 vs 21 min, P = 0.05), despite larger tumours being treated with LPN (3 vs 2.4 cm, P < 0.01) in this subset. CONCLUSIONS RPN is a developing procedure, and is technically feasible and safe, albeit with a longer warm WIT than LPN. Further experience is necessary to determine the relative merits of RPN. KEYWORDS kidney, laparoscopic, robotic, partial nephrectomy, renal, tumour, nephron- sparing surgery Study Type – Therapy (case control) Level of Evidence 3b OBJECTIVES To evaluate the relative merits of robotically assisted partial nephrectomy (RPN), using a matched-pair analysis, with laparoscopic PN (LPN). PATIENTS AND METHODS Between July 2006 and August 2007, 12 patients had RPN for tumour; the outcomes were compared retrospectively with 12 matched patients who had LPN. Patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, tumour side, size and location, and the specific technique used (early vs INTRODUCTION The incidence of renal cancer increased annually by nearly 2–4% between 1975 and 1995 [1,2]. The greatest increase in incidence was for localized tumours, attributed in part to a significant increase in the use of cross- sectional abdominal imaging [1]. At present, of all renal tumours, 48–66% are small, localized and incidentally detected [3]. Up to 38% of renal tumours surgically excised in contemporary practice are ≤ 4 cm [4]. Despite recent developments in probe-ablative therapies, surgical excision remains the cornerstone of treatment for RCC. Open partial nephrectomy (OPN) has been the reference standard for managing the small renal mass, with the potential benefit of better renal functional outcomes [5,6] and equivalent cancer control to radical nephrectomy [7–10]. However, OPN entails the morbidity of the muscle-cutting, open- flank incision, which can be durable in up to half of patients [11]. In addition, substantially many ( ≈ 30%) of small solid renal masses are benign [12]. The clear and present need to decrease procedure-related morbidity has fuelled significant advances in minimally invasive nephron-sparing surgery (MINSS) in the last 5 years. For extirpative MINSS, the reference standard is laparoscopic PN (LPN); this involves intricate tumour excision and precise suturing in a time-sensitive manner. With the stated intent of facilitating intracorporeal suturing robotically assisted PN (RPN) has been explored by a few authors, and remains under development [13–17]. At our institution, our experience with LPN is robust, with > 800 contemporary patients; as such, we sought to evaluate the relative merits of RPN from a team with wide experience of LPN. PATIENTS AND METHODS Between July 2006 and August 2007, 12 selected patients had RPN for a single small unilateral renal mass. The perioperative and 3-month functional outcomes were compared with those of 12 matched patients treated with LPN in the same period. Patients were matched retrospectively on the basis of age (within 10 years), gender, body mass index (BMI; within 5 points), American Society of BJUI BJU INTERNATIONAL