‘Trifecta’ outcomes of robot-assisted partial nephrectomy: Results of the ‘low volume’ surgeon

Abstract

Objective: There is limited data regarding surgeon volume and partial nephrectomy outcomes. The aim of this study is to report trifecta outcomes of robot-assisted partial nephrectomy (RAPN) performed by the low volume surgeon. Materials and Methods: Thirty-nine patients with clinical T1-2 renal tumors who underwent RAPN between 2012 and 2018 were included in this study. Trifecta was defined as negative surgical margins, warm ischemia time ≤20 minutes, and no operative complications. Patient demographics, R.E.N.A.L. nephrometry score, operation time, estimated blood loss, warm ischemia time, length of hospital stay, renal functions, and oncological outcomes were analyzed retrospectively. Complications were graded based on the modified Clavien-Dindo classification system. Results: The median R.E.N.A.L. nephrometry score was 6 (4-10). RAPN was successfully performed in all but one patient. The median operation time was 180 (90-240) minutes. Warm ischemia was performed only by segmental renal artery control in 35 and, by main renal artery control in three patients. The off-clamp technique was used in two patients. The median warm ischemia time was 16 (0-31) minutes. Seven patients had a warm ischemia time of longer than 20 minutes. Three patients had postoperative complications. The surgical margin was positive in one patient. As a result, the trifecta was achieved in 30 of the 39 patients (77%). Conclusion: RAPN is a safe and effective minimally invasive alternative in the treatment of renal masses. The present study suggests that reasonable trifecta rates can be achieved even by low volume surgeons.

Outcomes of Robotic Surgery for Low-Volume Surgeons

“…After propensity score matching, the authors did not find any significant differences in anesthesia time, blood transfusions, and complication rates between low-volume and high-volume centers [39]. Similarly, data from a single-center study in Turkey confirmed that a comparable trifecta outcome (77%) can be achieved by low-volume surgeon [40].…”

Trifecta achievement in patients undergoing partial nephrectomy: a systematic review and meta-analysis of predictive factors

“…It provides a definition of an ideal surgical outcome that includes the following three criteria: negative surgical margins, maximum renal function retention and patient recovery without complications. The use of trifecta rate as a key indicator of partial nephrectomy success has been widely reported (8)(9)(10)(11). Recently, some researchers have proposed several anatomic classification scoring systems to classify and stratify patients into different anatomic complexity groups, and allow doctors to evaluate perioperative outcomes (12)(13)(14)(15).…”

Analysis of surgical and histopathological results of robot-assisted partial nephrectomy with use of three or four robotic arms: an early series results

“…Since Gettman et al described robotic partial nephrectomy (4), the procedure has spread significantly as an option for minimally invasive surgical treatment of small renal masses (5). The learning curve of minimally invasive partial nephrectomy can be reduced with the use of robotic platform as recently published in two series which showed that reasonable 'Trifecta' rates can be achieved even by low volume surgeons (6), and even with surgeons without previously laparoscopic experience (7). Robotic surgery offers all the benefits of minimally invasive procedures: shorter length of stay, less postoperative pain, reduced estimated blood loss and faster recovery (8).…”