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OBJECTIVES To identify predictors of renal function preservation, and to compare the global and split renal function outcomes of robot-assisted partial nephrectomy and laparoscopic partial nephrectomy. METHODS Demographic, operative and pathological data, as well as renal function outcomes, of 251 patients who underwent laparoscopic (n = 104) and robot-assisted (n = 147) partial nephrectomy between 2008 and 2018 were retrospectively analyzed. Propensity score matching (1:1) was carried out to adjust for potential baseline confounders. Functional outcomes were assessed based on the estimated glomerular filtration rate and dynamic renal scintigraphy (using 99m Tc-mercaptoacetyltriglycine), including renal volumetric analysis. RESULTS A total of 98 patients were allocated to each partial nephrectomy group. Ischemic (laparoscopic vs robot-assisted partial nephrectomy: 29 vs 15 min, P

We investigated the relationship between the surgical navigation system and postoperative parenchyma preservation volume, and assessed the feasibility of image guided surgery in robot-assisted partial nephrectomy.We developed surgical navigation with registration between real-time endoscopic images using 3-dimensional virtual reality models for robot-assisted partial nephrectomy. Surgical outcomes of 44 (nonsurgical navigation group) and 102 (surgical navigation group) patients between June 2013 and December 2018 were retrospectively analyzed. To adjust for potential baseline confounders propensity score matching (1:1) was performed. Renal parenchymal preservation rate and extraparenchymal volume with a tumor including functional and oncological outcomes ("trifecta" defined as warm ischemia time of less than 25 minutes, no complications and negative surgical margins; "pentafecta" defined as trifecta plus greater than 90% preservation of estimated glomerular filtration rate at 12 months postoperatively and chronic kidney disease up staging) were evaluated using volumetric analysis and compared.After matching, 42 patients were allocated to each group. No significant differences in baseline characteristics; complications; and intraoperative, trifecta and pentafecta outcomes were observed between the 2 groups. Pathological T stages were significantly different between the groups (T1a/T1b/T2a or more 25/10/7 in the nonsurgical navigation group vs 35/7/0 in the surgical navigation group, p=0.003). Extraparenchymal volumes and parenchyma volume preservation rates were significantly higher in the surgical navigation group (21.4 vs 17.2 ml, p=0.041 and 83.5% vs 90.0%, p=0.042, respectively). Surgical navigation was positively associated with improved parenchyma preservation volume (p=0.003).Surgical navigation preserves renal parenchyma in robot-assisted partial nephrectomy and may contribute to improvement in postoperative renal function.

The present study aimed to evaluate the possibility of performing radical prostatectomy (RP) alone to achieve a radical cure for prostate cancer in the intermediate-risk group. Samples were collected from 638 Japanese patients who underwent antegrade RP between August 1998 and May 2013; subsequently, 157 patients were excluded. According to the D'Amico criteria, the low-, intermediate- and high-risk groups comprised 107, 222 and 152 patients, respectively. The 5-year prostate-specific antigen (PSA) failure-free survival rates in the low-, intermediate-, and high-risk groups were 96.5, 88.9 and 72.6%, respectively (P