Retroperitoneal robot-assisted partial nephrectomy for posterior renal masses is associated with earlier hospital discharge: A single-institution retrospective comparison

Purpose: To compare perioperative outcomes, specifically hospital length of stay (LOS), after retroperitoneal and conventional transperitoneal robot-assisted partial nephrectomy (RAPN). Patients and Methods: We retrospectively compared consecutive patients with a posterior renal mass undergoing retroperitoneal RAPN (n=116) versus transperitoneal RAPN (n=97) at our institution between July 2007 and March 2014. The surgical approach was based on patient and tumor characteristics, history of abdominal surgery, and surgeon preference. The primary outcome was postoperative LOS, and secondary outcomes included complication rate, inpatient narcotic pain medication use, and inpatient antiemetic use. Results: Baseline patient and tumor characteristics were similar between groups. A significantly great proportion of patients undergoing retroperitoneal RAPN had LOS equal to 1 day (57% vs 10%, P<0.01). Complication rates were similar between groups (P=0.37). Median pain medication use was also similar between groups (P=0.85). A significantly greater proportion of retroperitoneal RAPN patients, however, needed no antiemetics postoperatively (59% vs 43%, P=0.02). On multivariate analysis, transperitoneal RAPN was a significant predictor of LOS greater than 1 day (odds ratio=7.4, P<0.01), when controlling for age, sex, body mass index, patient comorbidity, previous abdominal surgery, baseline kidney function, nephrometry score, and tumor size. Conclusions: For patients with posterior renal masses, retroperitoneal RAPN significantly reduces their hospital LOS when compared with transperitoneal RAPN.