Single-port Vs Multi-port Robot-assisted Renal Surgery: Analysis of Perioperative Outcomes for Excision of High and Low Complexity Renal Masses

Overview

Journal J Robot Surg

Publisher Springer

Specialties Biotechnology
General Surgery

Date 2023 May 31

PMID 37256454

Authors

James M Berry

Hayden Hill

Joel M Vetter

Sam B Bhayani

Grant M Henning

Nicholas A Pickersgill

Arjun Sivaraman

R Sherburne Figenshau

Eric H Kim

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Comparison of single-port versus multi-port robotic assisted partial nephrectomy: a systematic review and meta-analysis of perioperative and oncological outcomes.

Hu A, Lv Z, Chen G, Lin Y, Zhu X, Li J J Robot Surg. 2024; 18(1):321.

PMID: 39136882 DOI: 10.1007/s11701-024-02066-7.

Surgical outcomes of novel retroperitoneal low anterior vs posterior and transperitoneal access in single-port partial nephrectomy.

Cannoletta D, Pellegrino A, Pettenuzzo G, Morgantini L, Calvo R, Torres-Anguiano J World J Urol. 2024; 42(1):387.

PMID: 38958744 DOI: 10.1007/s00345-024-05096-w.

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

Liang J, Liu X, Hu J J Robot Surg. 2024; 18(1):165.

PMID: 38581601 DOI: 10.1007/s11701-024-01925-7.

References

Campbell S, Clark P, Chang S, Karam J, Souter L, Uzzo R . Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. J Urol. 2021; 206(2):199-208. DOI: 10.1097/JU.0000000000001911. View

van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A . A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2010; 59(4):543-52. DOI: 10.1016/j.eururo.2010.12.013. View

Scosyrev E, Messing E, Sylvester R, Campbell S, van Poppel H . Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol. 2013; 65(2):372-7. DOI: 10.1016/j.eururo.2013.06.044. View

Dobbs R, Halgrimson W, Talamini S, Vigneswaran H, Wilson J, Crivellaro S . Single-port robotic surgery: the next generation of minimally invasive urology. World J Urol. 2019; 38(4):897-905. DOI: 10.1007/s00345-019-02898-1. View

Glaser Z, Burns Z, Fang A, Saidian A, Magi-Galluzzi C, Nix J . Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements. J Robot Surg. 2021; 16(3):695-703. DOI: 10.1007/s11701-021-01271-y. View

Abaza R, Murphy C, Bsatee A, Brown Jr D, Martinez O . Single-port Robotic Surgery Allows Same-day Discharge in Majority of Cases. Urology. 2020; 148:159-165. DOI: 10.1016/j.urology.2020.08.092. View

Francavilla S, Abern M, Dobbs R, Vigneswaran H, Talamini S, Antonelli A . Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1). Minerva Urol Nephrol. 2021; 74(2):216-224. DOI: 10.23736/S2724-6051.21.03919-9. View

Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J . Single-institution Cost Comparison: Single-port Versus Multiport Robotic Prostatectomy. Eur Urol Focus. 2020; 7(3):532-536. DOI: 10.1016/j.euf.2020.06.010. View

Kaouk J, Garisto J, Eltemamy M, Bertolo R . Pure Single-Site Robot-Assisted Partial Nephrectomy Using the SP Surgical System: Initial Clinical Experience. Urology. 2018; 124:282-285. DOI: 10.1016/j.urology.2018.11.024. View

10.

Kutikov A, Uzzo R . The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009; 182(3):844-53. DOI: 10.1016/j.juro.2009.05.035. View

11.

Schiavina R, Novara G, Borghesi M, Ficarra V, Ahlawat R, Moon D . PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int. 2016; 119(3):456-463. DOI: 10.1111/bju.13628. View

12.

Kim E, Larson J, Potretzke A, Hulsey N, Bhayani S, Figenshau R . Retroperitoneal Robot-Assisted Partial Nephrectomy for Posterior Renal Masses Is Associated with Earlier Hospital Discharge: A Single-Institution Retrospective Comparison. J Endourol. 2015; 29(10):1137-42. DOI: 10.1089/end.2015.0076. View

13.

Krishnan N, Zappia J, Calaway A, Nagle R, Sundaram C, Boris R . Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy. J Endourol. 2021; 36(1):71-76. DOI: 10.1089/end.2021.0075. View

14.

Okhawere K, Beksac A, Wilson M, Korn T, Meilika K, Harrison R . A Propensity-Matched Comparison of the Perioperative Outcomes Between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy: A Report from the Single Port Advanced Research Consortium (SPARC). J Endourol. 2022; 36(12):1526-1531. DOI: 10.1089/end.2022.0115. View

15.

Palacios A, Morgantini L, Trippel R, Crivellaro S, Abern M . Comparison of Perioperative Outcomes Between Retroperitoneal Single-Port and Multiport Robot-Assisted Partial Nephrectomies. J Endourol. 2022; 36(12):1545-1550. DOI: 10.1089/end.2022.0346. View

16.

Abaza R, Kogan P, Martinez O . Impact of the COVID-19 Crisis on Same-day Discharge After Robotic Urologic Surgery. Urology. 2021; 149:40-45. PMC: 7817411. DOI: 10.1016/j.urology.2021.01.012. View

17.

Balasubramanian S, Ronstrom C, Shiang A, Vetter J, Sheets J, Palka J . Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy. World J Urol. 2022; 41(1):35-41. PMC: 9629187. DOI: 10.1007/s00345-022-04204-y. View

18.

Mittakanti H, Heulitt G, Li H, Porter J . Transperitoneal vs. retroperitoneal robotic partial nephrectomy: a matched-paired analysis. World J Urol. 2019; 38(5):1093-1099. DOI: 10.1007/s00345-019-02903-7. View

19.

Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe B, Bhandari M . Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database. World J Urol. 2022; 40(9):2283-2291. DOI: 10.1007/s00345-022-04101-4. View

20.

Xia L, Wang X, Xu T, Guzzo T . Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy. J Endourol. 2016; 31(9):893-909. DOI: 10.1089/end.2016.0351. View