Evolution from laparoscopic to robotic nephron sparing surgery: a high-volume laparoscopic center experience on achieving ‘trifecta’ outcomes
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To evaluate the transition from laparoscopic (LPN) to robotic partial nephrectomy (RPN) in our institution using ‘trifecta’ outcomes as surrogate marker of efficacy.
Patients and methods
We identified 347 patients (LPN = 303, RPN = 44) in our prospectively maintained PN database between 2000 and 2014. The patients were chronologically divided into G1—first 151 LPN cases, G2—subsequent 152 LPN cases and G3—all RPN patients. Trifecta outcomes were defined as warm ischemia time (WIT) ≤25 min, no positive surgical margin (PSM) and complications ≤Clavien 2. Multivariable logistic model was used to analyze the predictors of the trifecta outcomes.
The tumor complexity significantly increased from G1 to G3. We achieved lower WIT and less high-grade complication (Clavien ≥ 3) from G1 to G2, and the trend continued even with transition to RPN. PSM was consistently low throughout the transition. Renal functional outcomes always showed a significant positive trend, and with RPN, we achieved improved recovery of renal function (44 vs 57 vs 82 %, p < 0.05). The overall 'trifecta' rates increased significantly from G1 to G2 and reached 81.8 % in RPN (48 vs 75.6 vs 81 %, p < 0.01). Multivariate analysis has shown that the use of robot has significant effect on achieving overall trifecta. The limitations of the study are being retrospective and non-randomized, and the trifecta definitions were not externally validated.
Our transition to RPN was essentially a continuation of our previous LPN experience as we continue to achieve higher ‘trifecta’ rates inspite of increasing tumor complexity
KeywordsKidney neoplasm Nephron sparing surgery Partial nephrectomy Trifecta Robotic surgery
Conflict of interest
The authors declare they have no conflicts of interest.
The Ethics Committee of the Institut Mutualiste Montsouris approved the study, and the principles of the Declaration of Helsinki were respected.
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