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

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

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


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

Original languageEnglish
Pages (from-to)2039-2044
Number of pages6
JournalWorld Journal of Urology
Issue number12
StatePublished - Dec 1 2015


  • Kidney neoplasm
  • Nephron sparing surgery
  • Partial nephrectomy
  • Robotic surgery
  • Trifecta


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