Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.
Hackensack Meridian School of Medicine, Hackensack, NJ, USA.
J Robot Surg. 2023 Feb;17(1):223-231. doi: 10.1007/s11701-022-01415-8. Epub 2022 Jun 1.
The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [- 0.13 (95% CI; - 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.
本研究旨在通过倾向评分匹配分析比较单端口和多端口机器人辅助腹腔镜部分肾切除术的围手术期和短期功能及肿瘤学结果。我们评估了 2019 年 1 月至 2020 年 10 月期间在我院行机器人辅助部分肾切除术的所有患者。收集并分析了患者的人口统计学、术中数据和术后结果。使用最优匹配法对年龄、性别、体重指数、既往腹部手术和肾切除术评分进行了倾向评分匹配。进行了事后敏感性分析以检查结果的稳健性。共对 48 例单端口和 238 例多端口机器人辅助部分肾切除术患者进行了评估。在进行倾向评分匹配后，将 48 例多端口病例按 1:1 与单端口病例进行匹配。单端口组术后第 1 天的中位数阿片类药物用量较低（4.6 vs 9.8 MME，p = 0.0209）和累积住院时间（5.1 vs 9.3 MME，p = 0.0357）。单端口组的中位住院时间也较短（1.4 vs 1.6 天，p = 0.0045），但事后敏感性分析显示两组之间无差异[-0.13（95% CI；-0.580，0.315，p = 0.5607）。手术时间、估计失血量、缺血时间、输血和阳性切缘率无显著差异。总之，根据我们的初步经验，单端口机器人辅助部分肾切除术是多端口机器人辅助部分肾切除术的一种安全且可接受的替代方法，可提供相似的围手术期和术后结果，同时减少住院期间阿片类药物的使用。
