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Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes

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Abstract

The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [− 0.13 (95% CI; − 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33. https://doi.org/10.3322/caac.21654

    Article  PubMed  Google Scholar 

  2. Simard EP, Ward EM, Siegel R, Jemal A (2012) Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin 62:118–128. https://doi.org/10.3322/caac.20141

    Article  PubMed  Google Scholar 

  3. Choo SH, Lee SY, Sung HH et al (2014) Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisons by nephrometry scores. World J Urol 32:1523–1529. https://doi.org/10.1007/s00345-014-1312-7

    Article  PubMed  Google Scholar 

  4. Gul ZG, Tam A, Badani KK (2020) Robotic partial nephrectomy: the current status. Indian J Urol IJU J Urol Soc India 36:16–20. https://doi.org/10.4103/iju.IJU_174_19

    Article  Google Scholar 

  5. Billah MS, Stifelman M, Munver R et al (2020) Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol 9:870–878. https://doi.org/10.21037/tau.2020.01.06

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhang M, Thomas D, Salama G, Ahmed M (2020) Single port robotic radical cystectomy with intracorporeal urinary diversion: a case series and review. Transl Androl Urol 9:925–930. https://doi.org/10.21037/tau.2020.01.19

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lenfant L, Sawczyn G, Aminsharifi A et al (2020) Pure single-site robot-assisted radical prostatectomy using single-port versus multiport robotic radical prostatectomy: a single-institution comparative study. Eur Urol Focus. https://doi.org/10.1016/j.euf.2020.10.006

    Article  PubMed  Google Scholar 

  8. Huang MM, Schwen ZR, Biles MJ et al (2021) A comparative analysis of surgical scar cosmesis based on operative approach for radical prostatectomy. J Endourol 35:138–143. https://doi.org/10.1089/end.2020.0649

    Article  PubMed  Google Scholar 

  9. Maurice MJ, Ramirez D, Kaouk JH (2017) Robotic laparoendoscopic single-site retroperitoneal renal surgery: initial investigation of a purpose-built single-port surgical system. Eur Urol 71:643–647. https://doi.org/10.1016/j.eururo.2016.06.005

    Article  PubMed  Google Scholar 

  10. Kaouk J, Garisto J, Eltemamy M, Bertolo R (2019) Pure single-site robot-assisted partial nephrectomy using the SP surgical system: initial clinical experience. Urology 124:282–285. https://doi.org/10.1016/j.urology.2018.11.024

    Article  PubMed  Google Scholar 

  11. Kaouk J, Aminsharifi A, Sawczyn G et al (2020) Single-port robotic urological surgery using purpose-built single-port surgical system: single-institutional experience with the first 100 cases. Urology 140:77–84. https://doi.org/10.1016/j.urology.2019.11.086

    Article  PubMed  Google Scholar 

  12. Fang AM, Saidian A, Magi-Galluzzi C et al (2020) Single-port robotic partial and radical nephrectomies for renal cortical tumors: initial clinical experience. J Robot Surg 14:773–780. https://doi.org/10.1007/s11701-020-01053-y

    Article  PubMed  Google Scholar 

  13. Shukla D, Small A, Mehrazin R, Palese M (2021) Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes. J Robot Surg 15:293–298. https://doi.org/10.1007/s11701-020-01106-2

    Article  PubMed  Google Scholar 

  14. Feliciano J, Stifelman M (2012) Robotic retroperitoneal partial nephrectomy: a four-arm approach. JSLS 16:208–211. https://doi.org/10.4293/108680812x13427982376149

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kaouk JH, Khalifeh A, Hillyer S et al (2012) Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur Urol 62:553–561. https://doi.org/10.1016/j.eururo.2012.05.021

    Article  PubMed  Google Scholar 

  16. Alexander K, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853. https://doi.org/10.1016/j.juro.2009.05.035

    Article  Google Scholar 

  17. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  18. Deng W, Zhou Z, Zhong J et al (2020) Retroperitoneal laparoscopic partial versus radical nephrectomy for large (≥ 4 cm) and anatomically complex renal tumors: a propensity score matching study. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 46:1360–1365. https://doi.org/10.1016/j.ejso.2019.12.010

    Article  Google Scholar 

  19. Zeuschner P, Greguletz L, Meyer I et al (2021) Open versus robot-assisted partial nephrectomy: a longitudinal comparison of 880 patients over 10 years. Int J Med Robot 17:e2167. https://doi.org/10.1002/rcs.2167

    Article  Google Scholar 

  20. Austin PC (2008) A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 27:2037–2049. https://doi.org/10.1002/sim.3150

    Article  PubMed  Google Scholar 

  21. Winfield HN, Donovan JF, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol 7:521–526. https://doi.org/10.1089/end.1993.7.521

    Article  CAS  PubMed  Google Scholar 

  22. Fan X, Lin T, Xu K et al (2012) Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 62:601–612. https://doi.org/10.1016/j.eururo.2012.05.055

    Article  PubMed  Google Scholar 

  23. Komninos C, Shin TY, Tuliao P et al (2014) R-LESS partial nephrectomy trifecta outcome is inferior to multiport robotic partial nephrectomy: comparative analysis. Eur Urol 66:512–517. https://doi.org/10.1016/j.eururo.2013.10.058

    Article  PubMed  Google Scholar 

  24. Li X, Zhang S, Xiao F (2020) Influence of chronic kidney disease on early clinical outcomes after off-pump coronary artery bypass grafting. J Cardiothorac Surg 15:199. https://doi.org/10.1186/s13019-020-01245-5

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ning C, Hu X, Liu F et al (2019) Post-surgical outcomes of patients with chronic kidney disease and end stage renal disease undergoing radical prostatectomy: 10-year results from the US National Inpatient Sample. BMC Nephrol 20:278. https://doi.org/10.1186/s12882-019-1455-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Maurice MJ, Kaouk JH, Ramirez D et al (2017) Robotic partial nephrectomy for posterior tumors through a retroperitoneal approach offers decreased length of stay compared with the transperitoneal approach: a propensity-matched analysis. J Endourol 31:158–162. https://doi.org/10.1089/end.2016.0603

    Article  PubMed  Google Scholar 

  27. Brummett CM, Waljee JF, Goesling J et al (2017) New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152:e170504. https://doi.org/10.1001/jamasurg.2017.0504

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kaouk J, Aminsharifi A, Wilson CA et al (2020) Extraperitoneal versus transperitoneal single port robotic radical prostatectomy: a comparative analysis of perioperative outcomes. J Urol 203:1135–1140. https://doi.org/10.1097/JU.0000000000000700

    Article  PubMed  Google Scholar 

  29. Orosco RK, Tam K, Nakayama M et al (2019) Transoral supraglottic laryngectomy using a next-generation single-port robotic surgical system. Head Neck 41:2143–2147. https://doi.org/10.1002/hed.25676

    Article  PubMed  Google Scholar 

  30. Kobari Y, Takagi T, Yoshida K et al (2021) Comparison of postoperative recovery after robot-assisted partial nephrectomy of T1 renal tumors through retroperitoneal or transperitoneal approach: a Japanese single institutional analysis. Int J Urol 28:183–188. https://doi.org/10.1111/iju.14424

    Article  CAS  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA

    Robert Harrison, Mutahar Ahmed, Mubashir Billah, Fahad Sheckley, Christina Caviasco, Angeline Sanders, Gregory Lovallo & Michael Stifelman

  2. Hackensack Meridian School of Medicine, Hackensack, NJ, USA

    Mutahar Ahmed, Gregory Lovallo & Michael Stifelman

  3. Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA

    Tina Lulla

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  1. Robert Harrison
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  9. Michael Stifelman
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Contributions

Study conception and design: RH, MA, MB, and MS. Analysis and interpretation of data: RH, MA, MB, AS, MS. Drafting of the manuscript: RH, MA, MB, AS, and MS. Critical revision of the manuscript for important intellectual content: RH, MA, MB, FS, TL, CC, AS, GL, and MS. Statistical analysis: AS. Obtaining funding: None. Administrative, technical, or material support: MA, and MS. Supervision: MA and MS. Other: None.

Corresponding author

Correspondence to Robert Harrison.

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Conflict of interest

Robert Harrison, Mubashir Billah, Fahad Sheckley, Tina Lulla, Christina Caviasco, Angeline Sanders, and Gregory Lovallo have no conflicts of interest or financial ties to disclose. Michael Stifelman is on the scientific advisory board of Intuitive Surgery and has an educational agreement with Ethicon. Mutahar Ahmed is a consultant for CONMED and Intuitive Surgical.

Informed consent

All procedures 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. The authors affirm that human research participants provided informed consent for publication of the images in Supplementary Fig. 1.

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Harrison, R., Ahmed, M., Billah, M. et al. Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robotic Surg 17, 223–231 (2023). https://doi.org/10.1007/s11701-022-01415-8

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  • DOI: https://doi.org/10.1007/s11701-022-01415-8

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