# Retroperitoneal Versus Transperitoneal Robot Assisted Partial Nephrectomy: A Prospective Controlled Non‐Randomized Single Centre Study Non‐Inferiority Design

## TL;DR

This study compares two surgical approaches for kidney surgery and finds both methods equally effective.

## Contribution

The study provides new evidence that the retroperitoneal approach is not inferior to the transperitoneal approach in robot-assisted partial nephrectomy.

## Key findings

- Trifecta achievement was 82% in R-RAPN and 76% in T-RAPN groups.
- No statistical evidence of inferiority was found for the retroperitoneal approach.
- R-RAPN may be a suitable alternative for selected patients.

## Abstract

The value of the retroperitoneal (R‐RAPN) compared with the conventional transperitoneal (T‐RAPN) approach in robot‐assisted partial nephrectomy has not been finally clarified. The current work's objective was to prospectively investigate R‐RAPN versus T‐RAPN.

The study was designed as a prospective, controlled, non‐randomized study with a non‐inferiority design. The primary endpoint was Trifecta achievement. The sample size calculation required 141 T‐RAPN and 94 R‐RAPN.

When the recruitment target of 141 was reached in the T‐RAPN arm, only 34 R‐RAPN had been performed, so the study was terminated early. Trifecta as the main outcome parameter was achieved in 82% of the R‐RAPN and 76% of the T‐RAPN groups, so no sign for inferiority could be detected (p = 0.6).

In this prospective study, there was no evidence of inferiority of R‐RAPN compared to T‐RAPN for the Trifecta endpoint. R‐RAPN may be an individually advantageous alternative to T‐RAPN for selected patients.

The study was registered in the German Clinical Trials Register (DRKS00028619).