Introduction: In 2019, the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, introduced a robotics program. Since then, our group has transitioned all partial nephrectomies (PNs) to robotic surgery. Robotic-assisted surgeries add additional costs when compared to traditional techniques. Therefore, using Canadian-specific data allows us to analyze whether the use of robotics technology is justifiable. Herein, we compared outcomes among patients undergoing robotic-assisted laparoscopic PN (RALPN), open PN (OPN), and laparoscopic PN (LPN).

Methods: This is a single-center, retrospective cohort study comparing perioperative and postoperative outcomes of patients undergoing RALPN, OPN, or LPN at our institution. We used a contemporary series of OPNs and LPNs performed just before the introduction of RALPNs at our institution (February 1, 2019). The OPN and LPN cohort consisted of PNs performed from February 1, 2015, until February 1, 2019 (well-established program). The RALPN cohort consisted of PNs performed from February 1, 2019, to July 31, 2021 (early phase of our robotics program). Primary surgical and perioperative outcomes included estimated blood loss (EBL), warm ischemia time (WIT), operating room (OR) time, procedure time, length of stay (LOS), and intraoperative complications. Postoperative outcomes include creatinine, postoperative complications, and tumor pathology.

Results: Overall, 273 patients with 304 tumors underwent PNs consecutively during this study period. Twenty of the 273 patients had more than one tumor resected per renal unit (Table 1); 108 patients had OPNs, 83 LPNs, and 82 RALPNs. Baseline characteristics are shown in Table 1. RALPNs were found to have a shorter LOS (p<0.0005) (Table 2), shorter procedure time (p<0.005) (Table 2), and shorter mean OR time (p<0.0005) (Table 2), with no significant differences in intraoperative and postoperative complications between the three. There were no Clavien-Dindo grade IV or V complications for the RALPN group (Table 2). RALPNs were found to have a greater EBL than LPNs, but less than OPNs (p<0.05) (Table 2). Additionally, we found statistically significant differences in clamp time, postoperative creatinine, tumor stage, and tumor size between the three groups.

Conclusions: This study demonstrated that during the early phase of our robotics program, RALPNs had similar rates of low-grade complications with less high-grade complications, required less OR time, had shorter procedure times, and had lower LOS when compared to LPNs and OPNs.