Document Detail


Comparative Outcomes and Assessment of "Trifecta" in 500 Robotic and Laparoscopic Partial Nephrectomies: A Single Surgeon experience.
MedLine Citation:
PMID:  23079376     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To report a comparative analysis of a large series of LPN and RPN performed by a high volume single surgeon at a tertiary care institution. MATERIALS AND METHODS: Medical charts of 500patients who underwent minimally invasive PN by a single surgeon between March2002 and February2012 were retrospectively reviewed. Demographic and perioperative data were collected and statistically analyzed. R.E.N.A.L-nephrometry score was used to score the tumors and tumors that scored moderate and high complexity were designated as complex. Trifecta was set as a combination of: warm ischemia time<25 minutes, negative surgical margins, and no perioperative complications. RESULTS: Two groups were identified: RPN n=261 and LPN n=231. Both had similar demographics. RPN group was significantly more morbid (CCI 3.75vs.1.26;p<0.001), included more complex tumors (5.98vs.7.2RENAL-score;p<0.001)), had lower operative time (169.9vs.191.7min,p<0.001), WIT (17.9vs.25.2min;p<0.001), intraoperative (2.6%vs.5.6%,p<0.001) and postoperative (24.53%vs.32.03%;p=0.004) complications, and positive margin rate (2.9%vs.5.6%,p<0.001). Thus, a higher overall trifecta rate was observed for RPN (58.7%vs.31.6%,p<0.001). LPN-group had longer follow up (3.43vs.1.51years;p<0.001), and no significant difference in postoperative changes in renal function. Our main limitations are the retrospective nature, the arbitrary definition of the trifecta and shorter follow up with the RPN group. CONCLUSIONS: Our large comparative analysis shows that RPN offers a wider range of indications, better operative outcomes, and lower perioperative morbidity compared to LPN. Overall, the quest for trifecta seems to be better accomplished by RPN, thus likely to become the new standard technique for minimally invasive PN.
Authors:
Ali Khalifeh; Riccardo Autorino; Shahab P Hillyer; Humberto Laydner; Remi Eyraud; Kamol Panumatrassamee; Jean-Alexandre Long; Jihad H Kaouk
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-15
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Center for Laparoscopic & Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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