Department of Urology, Saiseikai Kazo Hospital, Saitama, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
J Endourol. 2022 Jun;36(6):762-769. doi: 10.1089/end.2021.0716.
In transperitoneal robot-assisted partial nephrectomy (RAPN), an L score of 3 points according to the RENAL nephrometry scoring system does not necessarily denote operative complexity. This study aimed to assess the efficacy of the newly defined longitudinal component to analyze the operative complexity of RAPN. We retrospectively analyzed transperitoneal RAPNs performed by a single experienced surgeon for renal tumors between 2017 and 2020. L component was defined as L'1 for midlocated tumors, L'2 for >50% below the polar line, and L'3 for >50% above the polar line. Multivariate regression analysis was performed to test associations between prolonged console time and preoperative factors. The perioperative outcomes were compared among the three cohorts of L' components using propensity score matching: L'1 L'3 and L'1 L'2. A total of 220 cases (L'1: 107, L'2: 65, L'3: 48) were analyzed. The median console time was prolonged (>130 minutes) in 55 patients (median 108, interquartile range: 90-130 minutes). Longitudinal location (L'3 odds ratio [OR]: 2.93, = 0.01; L'2 OR: 2.32, = 0.04), high Mayo adhesive probability score ( = 0.001), multiple renal arteries ( = 0.03), and large size ( = 0.04) were significantly associated with prolonged console time. After matching, 26 cases of L'1 and L'3 and 43 cases of L'1 and L'2 were selected. Console time (108 minutes 132 minutes, = 0.017) and warm ischemia time (17 minutes 22 minutes, = 0.03) were significantly longer in L'3 than in L'1. The difference in console time between L'1 and L'2 was not statistically significant (100 minutes 111 minutes, = 0.08). In the new longitudinal assessment, upper location predicted prolonged console time compared with a middle or lower location. The L' component may help preoperatively assess operative complexity.
在经腹腔机器人辅助部分肾切除术（RAPN）中，根据 RENAL 肾肿瘤评分系统，3 分的 L 评分不一定表示手术的复杂性。本研究旨在评估新定义的纵向成分对 RAPN 手术复杂性的分析效果。我们回顾性分析了 2017 年至 2020 年间由一位经验丰富的外科医生为肾肿瘤进行的经腹腔 RAPN。L 成分定义为中部位肿瘤的 L'1、极线下 50%以上的 L'2 和极线上 50%以上的 L'3。多变量回归分析用于测试延长控制台时间与术前因素之间的关联。使用倾向评分匹配比较三个 L'成分队列的围手术期结果：L'1 与 L'3、L'1 与 L'2。共分析了 220 例（L'1：107 例，L'2：65 例，L'3：48 例）。55 例（中位 108 分，四分位距：90-130 分）的控制台时间延长（>130 分钟）。纵向位置（L'3 比值比 [OR]：2.93， = 0.01；L'2 OR：2.32， = 0.04）、高 Mayo 粘连概率评分（ = 0.001）、多发肾动脉（ = 0.03）和大体积（ = 0.04）与延长控制台时间显著相关。匹配后，选择了 26 例 L'1 与 L'3 和 43 例 L'1 与 L'2。L'3 的控制台时间（108 分钟 132 分钟， = 0.017）和热缺血时间（17 分钟 22 分钟， = 0.03）明显长于 L'1。L'1 与 L'2 的控制台时间差异无统计学意义（100 分钟 111 分钟， = 0.08）。在新的纵向评估中，与中或下位置相比，上位置预测了延长的控制台时间。L 成分可能有助于术前评估手术的复杂性。
