Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol Focus. 2023 Nov;9(6):1059-1064. doi: 10.1016/j.euf.2023.06.004. Epub 2023 Jun 30.
In the surgical management of kidney tumors, such as in multiport technology, single-port (SP) robotic-assisted partial nephrectomy (RAPN) can be performed using the transperitoneal (TP) or retroperitoneal (RP) approach. However, there is a dearth of literature on the efficacy and safety of either approach for SP RAPN.
To compare the peri- and postoperative outcomes of the TP and RP approaches for SP RAPN.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) database of five institutions. All patients underwent SP RAPN for a renal mass between 2019 and 2022.
TP versus RP SP RAPN.
Baseline characteristics, and peri- and postoperative outcomes were compared between both the approaches using χ test, Fisher exact test, Mann-Whitney U test, and Student t test.
A total of 219 patients (121 [55.25%] TP, 98 [44.75%] RP) were included in the study. Of them, 115 (51.51%) were male, and the mean age was 60 ± 11 yr. RP had a significantly higher proportion of posterior tumors (54 [55.10%] RP vs 28 [23.14%] TP, p < 0.001), while other baseline characteristics were comparable between both the approaches. There was no statistically significant difference in ischemia time (18 ± 9 vs 18 ± 11 min, p = 0.898), operative time (147 ± 67 vs 146 ± 70 min, p = 0.925), estimated blood loss (p = 0.167), length of stay (1.06 ± 2.25 vs 1.33 ± 1.05 d, p = 0.270), overall complications (5 [5.10%] vs 7 [5.79%]), and major complication rate (2 [2.04%] vs 2 [1.65%], p = 1.000). No difference was observed in positive surgical margin rate (p = 0.472) or delta eGFR at median 6-mo follow-up (p = 0.273). Limitations include retrospective design and no long-term follow-up.
With proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.
The use of a single port (SP) is a novel technology for performing robotic surgery. Robotic-assisted partial nephrectomy (RAPN) is a surgery to remove a portion of the kidney due to kidney cancer. Depending on patient characteristics and surgeons' preference, SP can be performed via two approaches for RAPN: through the abdomen or through the space behind the abdominal cavity. We compared outcomes between these two approaches for patients receiving SP RAPN, finding that they were comparable. We conclude that with proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.
在肾脏肿瘤的外科治疗中，如多端口技术中，可以通过经腹腔（TP）或腹膜后（RP）途径进行单端口（SP）机器人辅助部分肾切除术（RAPN）。然而，关于 SP RAPN 的这两种途径的疗效和安全性的文献很少。
比较 TP 和 RP 途径用于 SP RAPN 的围手术期结果。
设计、地点和参与者：这是一项回顾性队列研究，使用了来自五个机构的单端口高级研究联盟（SPARC）数据库的数据。所有患者均在 2019 年至 2022 年间因肾肿块接受 SP RAPN。
TP 与 RP SP RAPN。
使用 χ 检验、Fisher 确切检验、Mann-Whitney U 检验和学生 t 检验比较两种方法的基线特征和围手术期结果。
共有 219 名患者（121 名[55.25%]TP，98 名[44.75%]RP）纳入研究。其中，115 名（51.51%）为男性，平均年龄为 60±11 岁。RP 中后位肿瘤的比例明显更高（54 名[55.10%]RP 与 28 名[23.14%]TP，p<0.001），而其他基线特征在两种方法之间无统计学差异。缺血时间（18±9 与 18±11 分钟，p=0.898）、手术时间（147±67 与 146±70 分钟，p=0.925）、估计失血量（p=0.167）、住院时间（1.06±2.25 与 1.33±1.05 d，p=0.270）、总并发症发生率（5[5.10%]与 7[5.79%]）和主要并发症发生率（2[2.04%]与 2[1.65%]，p=1.000）无统计学差异。阳性切缘率（p=0.472）或中位数 6 个月随访时的 delta eGFR（p=0.273）也无差异。局限性包括回顾性设计和缺乏长期随访。
根据患者和肿瘤特征进行适当的患者选择，外科医生可以选择 TP 或 RP 途径用于 SP RAPN，并保持满意的结果。
使用单端口（SP）是一种用于进行机器人手术的新技术。机器人辅助部分肾切除术（RAPN）是一种因肾癌而切除部分肾脏的手术。根据患者的特点和外科医生的偏好，SP 可以通过两种途径用于 RAPN：通过腹部或通过腹部后面的空间。我们比较了接受 SP RAPN 的患者这两种途径的结果，发现它们是可比的。我们得出结论，根据患者和肿瘤特征进行适当的患者选择，外科医生可以选择 TP 或 RP 途径用于 SP RAPN，并保持满意的结果。
