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Abstract
ObjectivesWe aim to compare the outcomes of a 3-arm versus a 4-arm robotic assisted partial nephrectomy (RAPN) using the da Vinci Si model; as well as, illustrate the deployment of long ports to decrease arm collision during the 4-arm approach.Patients and MethodsResults of RAPN in a Middle Eastern tertiary referral center from August 2013 to December 2017 are reported. Comparison between 3 versus 4-arm robotic approaches was done in regards to patient and tumor characteristics, operative parameters, and postoperative outcomes. Statistical analysis was performed with the Student’s t-test and chi-squared test.ResultsForty consecutive 3-arm RAPNs and 40 consecutive 4-arm RAPNs were retrospectively evaluated. Differences in tumor complexity between the two groups were statistically insignificant. Similarly, surgical margin positivity, mean ischemia time, estimated blood loss, length of hospital stay, and mean change in serum creatinine were statistically insignificant between the two groups. Mean operative time was significantly shorter by 42 minutes in the 4-arm vs 3-arm group (p=0.01).ConclusionsThe addition of a 4th arm in RAPN can be of benefit in centers that still rely on the da Vinci Si model. The ease of hilar dissection, retraction, and surgeon independence instigated a statistically significant decrease in operative time with 4-arm use.
Highlights
Open, laparoscopic, or robotic assisted partial nephrectomy is the surgical procedure of choice when dealing with small renal masses [1]
The addition of a 4th arm in robotic assisted partial nephrectomies (RAPN) can be of benefit in centers that still rely on the da Vinci Si model
RAPN proved superior to Laparoscopic partial nephrectomy (LPN) in terms of perioperative outcomes including lower open conversion rates, lower variations in postoperative estimated glomerular filtration rate, as well as shorter ischemia time, blood loss, and length of hospital stay [4,5]
Summary
Laparoscopic, or robotic assisted partial nephrectomy is the surgical procedure of choice when dealing with small renal masses [1]. Laparoscopic partial nephrectomy (LPN) requires exceedingly advanced laparoscopic skills especially during the time-constrained steps of warm ischemia time, such as tumor excision and primary renorrhaphy [2]. With the introduction of the robotic system, robotic assisted partial nephrectomies (RAPN) delivered an unprecedented level of minimally invasive surgery. RAPN proved superior to LPN in terms of perioperative outcomes including lower open conversion rates, lower variations in postoperative estimated glomerular filtration rate (eGFR), as well as shorter ischemia time, blood loss, and length of hospital stay [4,5]. We describe a comparative experience between the two approaches in terms of surgical parameters, operative marks, and postoperative outcomes
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