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Evolution from laparoscopic to robotic nephron sparing surgery: a high-volume laparoscopic center experience on achieving ‘trifecta’ outcomes

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Abstract

Objective

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.

Results

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.

Conclusions

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

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Conflict of interest

The authors declare they have no conflicts of interest.

Ethical standard

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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Authors and Affiliations

  1. Department of Urology, Institute Mutualiste Montsouris, 42, Boulevard Jourdan, 75674, Paris Cedex 14, France

    Arie Carneiro, Arjun Sivaraman, Rafael Sanchez-Salas, Ettore Di Trapani, Eric Barret, Francois Rozet, Marc Galiano, Facundo Uriburu Pizzaro, Steeve Doizi, Nathalie Cathala, Annick Mombet, Dominique Prapotnich & Xavier Cathelineau

Authors
  1. Arie Carneiro
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  2. Arjun Sivaraman
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  3. Rafael Sanchez-Salas
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  4. Ettore Di Trapani
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  5. Eric Barret
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  6. Francois Rozet
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  7. Marc Galiano
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  8. Facundo Uriburu Pizzaro
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  9. Steeve Doizi
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  11. Annick Mombet
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  12. Dominique Prapotnich
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  13. Xavier Cathelineau
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Corresponding author

Correspondence to Rafael Sanchez-Salas.

Additional information

Arie Carneiro and Arjun Sivaraman had the same position as first authors in this paper.

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Carneiro, A., Sivaraman, A., Sanchez-Salas, R. et al. Evolution from laparoscopic to robotic nephron sparing surgery: a high-volume laparoscopic center experience on achieving ‘trifecta’ outcomes. World J Urol 33, 2039–2044 (2015). https://doi.org/10.1007/s00345-015-1552-1

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  • DOI: https://doi.org/10.1007/s00345-015-1552-1

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