Abstract
To prospectively evaluate outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of surgical drains. 100 consecutive drainless RAPN performed by a single surgeon were analyzed following a previously published quantitative assessment of drain creatinine/serum creatinine ratios. This cohort was compared to 100 preceding RAPN with drains. Variables analyzed included pre-operative patient/tumor characteristics and post-operative outcomes including post-operative estimated glomerular filtration rate (eGFR), length of hospital stay (LOS), and complications. There was no significant difference in median patient age, sex, body mass index, ASA score, or pre-operative eGFR between the two groups. The preceding 100 patients with drains did have larger median renal size (3.5 vs 2.6 cm, p < 0.001), higher median RENAL scores (9 vs 8, p < 0.001), and longer warm ischemia time (21 vs 18 min, p = 0.004). Patients without drains had shorter median LOS (2.0 days vs 3.0 days, p < 0.001), fewer Grade III or higher post-operative complications (4% vs 10%, p = 0.007), and no difference in 1 month percent change in eGFR (− 13% vs − 11%, p = 0.84). After adjusting for confounding variables there was no difference in LOS (OR 1.50, p = 0.31), Grade III–V complications (OR 1.49, p = 0.63), or 1 month percent change in eGFR (OR 2.3, p = 0.41) between the two groups. One patient in the drainless group required a post-operative drain for a urine leak diagnosed 10 days following RAPN. Omission of drains is safe in RAPN and does not appear to offer a clinical advantage.
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Authors Amanda E. Kahn, Ashley M. Shumate, Colleen T. Ball, and David D. They declare that they have no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
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Kahn, A.E., Shumate, A.M., Ball, C.T. et al. Elimination of surgical drains following robotic-assisted partial nephrectomy. J Robotic Surg 13, 741–745 (2019). https://doi.org/10.1007/s11701-019-00922-5
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DOI: https://doi.org/10.1007/s11701-019-00922-5