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Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience

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Abstract

Purpose

Adoption of robotic retroperitoneal surgery has lagged behind robotic surgery adoption in general due to unique challenges of access and anatomy. We evaluated our initial results with robotic retroperitoneal robotic partial nephrectomy (RRPN) after transitioning from exclusively transperitoneal robotic partial nephrectomy (TRPN) to evaluate safety and any identifiable learning curve.

Methods

We evaluated our single-surgeon (RA) prospective partial nephrectomy database since adopting RRPN routinely for posterior tumors in 2017. The surgeon had previously performed 410 partial nephrectomies by this time. Outcomes were compared after the initial 30 RRPN.

Results

Of 137 patients since adopting RRPN, two attempted RRPN were converted to TRPN without complications due to morbid obesity affecting access, and 30 RRPN were completed (107 TRPN). There were no statistically significant differences in demographics, mean tumor size, or RENAL score between groups. Mean blood loss was lower in RRPN (53 mL vs 99 mL, P < 0.05), but there were no transfusions in either group. There was no difference in mean operative (127.8 min vs 141.2 min, P = 0.06) or ischemia time (11.1 min vs 10.8 min, P = 0.98). There were no positive margins in either group. Mean length of stay was lower in RRPN due to more same-day discharges (0.7 vs 0.9 days). There were no 90-day Clavien III–V complications. One RRPN patient was readmitted POD#8 overnight for hypoxia, and one visited the emergency room POD#7 for persistent pain. All three TRPN complications were managed as outpatients.

Conclusions

Successful adoption of RRPN can be achieved readily after experience with TRPN. Outcomes were immediately comparable without any identifiable learning curve.

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Abbreviations

RRPN:

Retroperitoneal robotic partial nephrectomy

TRPN:

Transperitoneal robotic partial nephrectomy

TP:

Transperitoneal

RP:

Retroperitoneal

WIT:

Warm ischemia time

eGFR:

Estimated glomerular filtration rate

LOS:

Length of stay

EBL:

Estimated blood loss

OT:

Operative time

BMI:

Body mass index

ASA:

American society anesthesiologist

IQR:

Interquartile range

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Authors and Affiliations

  1. Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, 7450 Hospital Dr., Dublin, OH, 43016, USA

    Ronney Abaza, Robert S. Gerhard & Oscar Martinez

Authors
  1. Ronney Abaza
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  2. Robert S. Gerhard
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  3. Oscar Martinez
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Contributions

RA: Project development, manuscript writing/editing. RG: Manuscript writing/editing, data analysis. OM: data collection. Data management, data analysis, manuscript writing.

Corresponding author

Correspondence to Oscar Martinez.

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The authors declare that there is no conflict of interest.

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Ethical standards have been met and this study is IRB approved.

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Abaza, R., Gerhard, R.S. & Martinez, O. Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience. World J Urol 38, 1087–1092 (2020). https://doi.org/10.1007/s00345-019-02935-z

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  • DOI: https://doi.org/10.1007/s00345-019-02935-z

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