Comparison between Two da Vinci Surgical Systems in Trifecta and Pentafecta Rates for Robot-Assisted Partial Nephrectomy

Abstract

Purpose: Comparative studies on the outcomes of robot-assisted partial nephrectomy (RAPN) procedures conducted using the da Vinci Xi and Si platforms remain sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates of the two robotic surgical platforms. Materials and Methods: A total of 338 patients who had undergone RAPN using da Vinci Si platform or Xi platform were included. Pentafecta was defined herein as Trifecta (a warm ischemia time <25 min, a negative surgical margin, and the absence of significant perioperative complications) with the addition of estimated glomerular filtration rate preservation of over 90% and no chronic kidney disease stage progression by 12 months postsurgery. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement. Results: The trifecta and pentafecta rates were higher in the Xi group than in the Si group (65% vs. 29%, P < 0.001 for trifecta; 31% vs. 14%, P = 0.001 for pentafecta). In addition, a significantly shorter average WIT (19 vs. 28 min, P < 0.001) and console time (141 vs. 163 min, P = 0.004) were identified in the Xi group than in the Si group. RAPN conducted using the Xi platform was independently associated with both higher achievement rates of trifecta and pentafecta. In addition, multivariate regression analyses revealed that no history of hypertension, low tumor complexity as measured using the RENAL nephrometry score, anterior orientation of the renal tumor were associated with higher Trifecta rates; while history of diabetes and anterior–posterior renal tumor orientation were the significant predictors of Pentafecta achievement, respectively. Conclusion: A significantly higher rates of trifecta and pentafecta achievement were observed in the Xi group than in the Si group. The use of the Xi platform was also significantly associated with low operative times and acceptable complication rates.