Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses.

Autor: Berry JM; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA. james.berry@wustl.edu., Hill H; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Vetter JM; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Bhayani SB; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Henning GM; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Pickersgill NA; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Sivaraman A; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Figenshau RS; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA., Kim EH; Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA. ehkim@wustl.edu.
Jazyk: angličtina
Zdroj: Journal of robotic surgery [J Robot Surg] 2023 Oct; Vol. 17 (5), pp. 2149-2155. Date of Electronic Publication: 2023 May 31.
DOI: 10.1007/s11701-023-01637-4
Abstrakt: 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.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)
Databáze: MEDLINE
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