TY - JOUR
T1 - Single-port vs multi-port robot-assisted renal surgery
T2 - analysis of perioperative outcomes for excision of high and low complexity renal masses
AU - Berry, James M.
AU - Hill, Hayden
AU - Vetter, Joel M.
AU - Bhayani, Sam B.
AU - Henning, Grant M.
AU - Pickersgill, Nicholas A.
AU - Sivaraman, Arjun
AU - Figenshau, R. Sherburne
AU - Kim, Eric H.
N1 - Funding Information:
Preliminary findings of this study were presented as an abstract at the 2022 AUA Annual Meeting and are published in the Scientific Program of the 2022 AUA Annual Meeting in the Journal of Urology.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.
PY - 2023/10
Y1 - 2023/10
N2 - There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4–6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
AB - There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4–6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
KW - Multi-port
KW - Nephrectomy
KW - Nephrometry score
KW - Outcomes research
KW - Robot-assisted partial nephrectomy
KW - Single-port
UR - http://www.scopus.com/inward/record.url?scp=85160781755&partnerID=8YFLogxK
U2 - 10.1007/s11701-023-01637-4
DO - 10.1007/s11701-023-01637-4
M3 - Article
C2 - 37256454
AN - SCOPUS:85160781755
SN - 1863-2483
VL - 17
SP - 2149
EP - 2155
JO - Journal of Robotic Surgery
JF - Journal of Robotic Surgery
IS - 5
ER -