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Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements

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Abstract

Evidence supporting the safe use of the single-port (SP) robot for partial nephrectomy is scarce. The purpose of this study was to compare perioperative outcomes for patients undergoing robotic assisted SP vs multi-port (MP) partial nephrectomy (PN) in a time-matched cohort. All patients with clinically localized renal masses who underwent robotic PN from January 2019 to March 2020 were evaluated. Patients were stratified according to SP vs MP approach. Postoperative analgesia was administered in accordance with department-wide opioid stewardship protocol and outpatient opioid use was tracked. Total of 78 patients underwent robotic PN with 26 patients in the SP cohort. The majority of renal masses had low-complexity (53, 67.9%) R.E.N.A.L. nephrometry scores, without a significant difference between the two cohorts (p = 0.19). A retroperitoneal approach was performed in 16 (20.5%) patients overall, though more commonly via the SP robotic approach (13 vs 3, p < 0.001). Mean operative time for SP cases was 183.9 ± 63.5 min vs 208.6 ± 65.0 min in the MP cohort (p = 0.12). Rate of conversion to radical nephrectomy was 3.8% vs 9.6% for SP vs MP cases, respectively, (p = 0.37). The majority of patients were discharged on postoperative day one (67.9%) irrespective of operative approach (p = 0.60). There were no differences in inpatient milligram morphine equivalents administered (MME, p = 0.08) or outpatient postoperative MME prescribed (p = 0.21) between the two cohorts. In this retrospective single-institution study, SP robotic approach offers similar short-term perioperative outcomes to MP platforms for minimally invasive, nephron-sparing surgery. Using the SP system was not associated with a reduction in postoperative opioid analgesic requirements.

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Authors and Affiliations

  1. Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 35294, USA

    Zachary A. Glaser, Zachary R. Burns, Andrew M. Fang, Ava Saidian, Jeffrey W. Nix & Soroush Rais-Bahrami

  2. Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA

    Cristina Magi-Galluzzi

  3. O’Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, USA

    Jeffrey W. Nix & Soroush Rais-Bahrami

  4. Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Soroush Rais-Bahrami

Authors
  1. Zachary A. Glaser
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  2. Zachary R. Burns
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  3. Andrew M. Fang
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  4. Ava Saidian
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  5. Cristina Magi-Galluzzi
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  6. Jeffrey W. Nix
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  7. Soroush Rais-Bahrami
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Contributions

ZAG: conceptualization, data curation, formal analysis, investigation, methodology, resources, validation, visualization, writing—original draft, and writing—review and editing. ZRB: conceptualization, data curation, investigation, resources, and writing—review and editing. AMF: conceptualization, data curation, investigation, resources, and writing—review and editing. AS: conceptualization, data curation, investigation, resources, and writing—review and editing. CM-G: data curation, investigation, resources, and writing—review and editing. JWN: data curation, funding acquisition, supervision, validation, visualization, and writing—review and editing. SR-B: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—original draft, and writing—review and editing.

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Correspondence to Zachary A. Glaser.

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Conflict of interest

Jeffrey W. Nix and Soroush Rais-Bahrami serve as consultants to Philips/InVivo Corp and Intuitive Surgical. Soroush Rais-Bahrami also serves as a consultant to Blue Earth Diagnostics, Genomic Health Inc, and Bayer Healthcare.

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Glaser, Z.A., Burns, Z.R., Fang, A.M. et al. Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements. J Robotic Surg 16, 695–703 (2022). https://doi.org/10.1007/s11701-021-01271-y

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  • DOI: https://doi.org/10.1007/s11701-021-01271-y

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