NEW YORK (Reuters Health) – When performed at centers of excellence, robotic partial nephrectomy (RPN) has “an acceptably low” complication rate that mirrors that of open partial nephrectomy and laparoscopic partial nephrectomy (LPN), a new study shows.

However, in a paper in the Journal of Urology for August, available online now, Dr. Jihad Kaouk, from the Glickman Urological and Kidney Institute, Cleveland Clinic Foundation in Cleveland, Ohio and colleagues say RPN is a “challenging operation that requires considerable robotic and laparoscopic experience.”

Their study is believed to be the largest series to date of RPN, specifically addressing the incidence and seriousness of perioperative complications. All 450 patients in the series had solitary renal tumors and underwent RPN at one of four high-volume centers between June 2006 and May 2009. All surgeries were performed via the transperitoneal approach using the da Vinci Surgical System.

The overall complication rate was 15.8% (71 of 450 patients). There were 8 intraoperative complications (1.8%) and 65 postoperative complications (14.4%). There were no deaths.

The most common complications were hemorrhage and urine leak. Hemorrhage occurred in 2 patients during surgery (0.2%) and 22 patients after surgery (4.9%); the rate of hemorrhage in this series, the authors note, is similar to that reported in a prior series. Seven patients (1.6%) had urine leakage.

Most of the complications were minor and manageable without an invasive procedure; using the Clavien system, complications were grade I-II in 76.1% of patients and grade III-IV in 23.9%.

Conversion to open or standard laparoscopic surgery was rare (3 patients; 0.7%), as was conversion to radical nephrectomy (7 patients; 1.6%), the authors report. “Our rates of conversion to open and to radical nephrectomy compare favorably to those in other large RPN and LPN series,” the study team notes.

The author of an editorial published with the paper notes that this series “likely represents the best possible results and may not directly apply to centers where there is less overall robotic experience.”

“It is important to determine whether the techniques can be widely disseminated or whether the procedures must be centralized at centers of excellence,” concludes Dr. Stephen J. Savage, a urologist at the Medical University of South Carolina in Charleston.

J Urol 2011.