MP59-18 IMPACT OF MAYO ADHESIVE PROBABILITY SCORE ON THE COMPLEXITY OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY.

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-18 IMPACT OF MAYO ADHESIVE PROBABILITY SCORE ON THE COMPLEXITY OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY. Ryo Ishiyama, Tsunenori Kondo, Toshio Takagi, Junpei Iizuka, Hirohito Kobayashi, Kenji Omae, Norihiro Fukuda, Hiroki Ishihara, and Kazunari Tanabe Ryo IshiyamaRyo Ishiyama More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , Kenji OmaeKenji Omae More articles by this author , Norihiro FukudaNorihiro Fukuda More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1834AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Adhesive perinephric fat (APF) increases the complexity of robot-assisted partial nephrectomy (RAPN). The Mayo adhesive probability (MAP) score is an index for quantifying APF and predicting prolonged operation time or increased surgical complication rate. However, the part of the operation influenced by increased MAP score remains unclear. METHODS The study subjects were 311 patients who underwent RAPN between January 2013 and June 2016 in our institute. MAP score was calculated to quantify APF. The perinephric fat thickness and stranding were used to calculate the MAP score. Operation time was divided into a dissection phase (from robotic manipulation to hilar clamping) and resection phase (from hilar clamping to robotic surgery completion). RESULTS The patients' mean age, body mass index (BMI), total operation time, console time, dissection phase time, and resection phase time were 60±13 years, 23.5±3.5 kg/m2, 180.8±40.7 minutes, 132.6±36.5 minutes, 84.9±27.6 minutes, and 47.6±18.3 minutes, respectively. The MAP score was 0 in 98 patients (32%), 1 in 86 (28%), 2 in 21 (7%), 3 in 48 (15%), 4 in 44 (14%), and 5 in 14 (4%). The dissection and resection phase times significantly increased as the MAP scores increased (Figure 1). The dissection phase times were 71.2, 79.1, 88.9, 97.0, 99.7, and 118.8 minutes as the MAP score increased by 1 point from 0 to 5 (p<0.001). The influence of MAP score was more remarkable to the prolongation of the dissection phase than to that of the resection phase. In the patients with MAP scores of =3, the dissection phase time was not significantly influenced by the learning curve (100.8±25.2, 103.7±29.4, and 98.2±31.4 minutes in 1st-100th, 101st-200th, and 201st-311th, respectively). We further examined the factors that influenced the dissection phase time of 100 minutes by using the logistic regression model. In the multivariate analysis, left side, early surgical experience (first 100 cases), the number of the renal arteries to be clamped and MAP score (=3) were the independent factors of prolonged dissection phase. CONCLUSIONS MAP score is an independent predictive factor of prolonged RAPN dissection phase. The complexity of RAPN in the patients with high MAP scores was still high even for experienced surgeons. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e788 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ryo Ishiyama More articles by this author Tsunenori Kondo More articles by this author Toshio Takagi More articles by this author Junpei Iizuka More articles by this author Hirohito Kobayashi More articles by this author Kenji Omae More articles by this author Norihiro Fukuda More articles by this author Hiroki Ishihara More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...