Mp49-06 a Helpful Tool in the Renal Surgery Armamentarium: Dorsal Lumbotomy Nephrectomy for Tumor in Patients With End-Stage Renal Disease

Abstract

INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RAPN) is a difficult procedure with risk of significant perioperative complications. We implemented the use of preoperative imaging for three-dimensional(3D) reconstructions for surgical planning and intraoperative guidance.The objective was to evaluate the impact of intraoperative guidance with 3D model reconstructions on perioperative outcomes of RAPN.METHODS: We conducted a retrospective analysis of all patients who underwent RAPN for kidney tumor by three high-volume expert surgeons from academic centers. Clinical data were collected prospectively after written consent into the French kidney cancer network database UroCCR(NCT03293563). Our cohort was divided in two groups: 3D-Image guided RAPN group(3D-IGRAPN) and control group. A propensity score according to age, preoperative renal function and RENAL tumor complexity score was used. Both surgical techniques were compared in terms of perioperative outcomes.RESULTS: The initial study cohort included 230 3D-IGRAPN and 415 control RAPN. Before propensity-score matching, patients in the 3D-IGRAPN group had a larger tumor(4.3 cm vs 3.5 cm, p<0.001) and higher RENAL complexity score(9 vs 8, p<0.001). Following propensity-score matching, there were 157 patients in both groups. The rate of major complications was lower for patients in the 3D-IGRAPN group (3.8% vs 9.5%, p[0.04). The median percentage of eGFR variation recorded at first follow-up was lower in the 3D-IGRAPN group(-5.6% vs -10.5%, p[0.002). The trifecta achievement rate was higher in the 3D-IGRAPN group(55.7% vs 45.1%; p[0.005).CONCLUSIONS: Three-dimensional kidney reconstructions allow reliable pre-operative planning and intraoperative surgical guidance which could lower risk of complications and improve perioperative clinical outcomes of RAPN.