Abstract
ABSTRACTObjective There is limited data regarding surgeon volume and partial nephrectomy outcomes. The aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon.Materials and Methods Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time ≤20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system.Results The median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. The median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. The off-clamp technique was used in two patients. The median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. The surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77%).Conclusion RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. The present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons.
Highlights
The incidence of renal tumors has increased worldwide over the last two decades due to widespread use of cross-sectional imaging techniques [1]
As has been shown in prior studies, higher surgeon volume was associated with better operative outcomes for radical prostatectomy and cystectomy; there are very few publications concerning the impact of surgeon volume on the robot-assisted partial nephrectomy (RAPN) outcomes [5, 6]
Nephrometry score Operation time, min Warm ischemia time, min Estimated blood loss, mL Drain removal time, days Length of stay, days Data indicated as median, BMI = Body mass index used to limit warm ischemia time in all but three patients
Summary
The incidence of renal tumors has increased worldwide over the last two decades due to widespread use of cross-sectional imaging techniques [1]. Nephron-sparing surgery (NSS) remains the preferred approach for the treatment of T1a, and when technically feasible, in T1b renal tumors since it provides superior functional outcomes and less cardiovascular events when compared to radical nephrectomy [2]. A new concept called ‘Trifecta’ has been suggested to evaluate the success of RAPN. It was first reported by Hung et al and defined as the simultaneous achievement of all three goals of RAPN including negative surgical margins, no operative complications, and renal functional preservation [4]. As has been shown in prior studies, higher surgeon volume was associated with better operative outcomes for radical prostatectomy and cystectomy; there are very few publications concerning the impact of surgeon volume on the RAPN outcomes [5, 6]. The aim of the present study was to evaluate trifecta outcomes of a low volume surgeon’s RAPN series and helping to fill a perceived gap in the literature, about the volume-outcome relationship of the RAPN
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