Transperitoneal robotic-assisted versus laparoscopic partial nephrectomy for renal duplication: a comparative clinical analysis

Abstract

This retrospective study aimed to compare the efficacy and safety of robotic-assisted laparoscopic partial nephrectomy (RALPN) versus laparoscopic partial nephrectomy (LPN) in pediatric patients with renal duplication. Data from 105 pediatric patients who underwent surgery for renal duplication at the Department of Pediatric Surgery, Fujian Provincial Hospital, between January 2019 and March 2024 were reviewed. Patients were categorized into two groups based on surgical approach: RALPN and LPN. The RALPN group had a significantly higher mean age (5.10 ± 2.63 years) compared to the LPN group (2.67 ± 2.16 years, p < 0.001). RALPN patients experienced shorter hospital stay (7.3 ± 1.7 days vs. 9.5 ± 3.3 days, p < 0.001)) and higher hospitalization expenses ($5,723 ± 1,322 vs. $1,787 ± 564, p < 0.001). No significant differences were observed in gender distribution, follow-up duration, BMI, side of surgery, presenting symptoms, coexisting urinary system diseases, or readmission rates between the groups. Intraoperative data showed that RALPN resulted in a trend towards lower blood loss (8.41 ± 3.58 ml vs. 10.73 ± 4.60 ml, p = 0.023) but required a longer total operation time (234.68 ± 58.02 min vs. 185.36 ± 54.07 min, p < 0.001). However, the partial nephrectomy duration was shorter in RALPN (125.45 ± 19.27 min vs. 153.49 ± 48.81 min, p < 0.001). RALPN had faster recovery with shorter durations of postoperative hematuria and catheterization. At 12 months post-surgery, RALPN showed significantly lower anteroposterior diameter of renal pelvis and maximum cross-sectional area of the cyst, indicating better preservation of renal function. Both RALPN and LPN are safe and effective for treating renal duplication in pediatric patients. Despite RALPN is associated with higher hospitalization costs, its overall cost-effectiveness may be comparable to LPN due to fewer complications and faster recovery. Further multicenter, randomized controlled trials are warranted to validate these findings and assess long-term outcomes.