Licari Leslie Claire, Bologna Eugenio, Franco Antonio, Ditonno Francesco, Manfredi Celeste, Huang Jonathan, Latchamsetty Kalyan, Coogan Christopher, Olweny Ephrem O, Cherullo Edward E, Chow Alexander K, Vourganti Srinivas, Autorino Riccardo
Department of Urology, Rush University, Chicago, IL, USA.
Department of Urology, Rush University, Chicago, IL, USA.
Eur J Surg Oncol. 2024 Mar;50(3):108011. doi: 10.1016/j.ejso.2024.108011. Epub 2024 Feb 8.
The aim of the study is to compare key outcomes of Single-Port (SP) and Multi-Port (MP) robot-assisted partial nephrectomy (RAPN).
A retrospective analysis was conducted on our prospectively collected database of patients who underwent SP-RAPN or MP-RAPN at our institution from January 2021 to August 2023. To adjust for potential baseline pre-operative confounders, a 1:1 propensity-score matching analysis (PSMa) was performed. The primary endpoint was to compare perioperative outcomes between the two groups. The secondary endpoint was to compare the achievement of the "Trifecta" outcome (defined as negative surgical margins, absence of high-grade complications and change in eGFR values (ΔeGFR) < 10% at 6 months follow-up) in the matched cohort.
After PSMa, 30 SP cases were matched 1:1 to 30 MP cases. In the matched cohort, there were no significant differences between SP and MP approaches in operative time, estimated blood loss, ischemia time, transfusions rate, intraoperative complications, postoperative complications, and positive surgical margin rates. Patients who underwent SP-RAPN had a shorter median length of stay [25 (IQR:24.0-34.5) vs 34 (IQR:30.2-48.0) hours, p < 0.003]. The Trifecta outcome was achieved in 16 (57%) of SP patients and 17 (63%) of MP patients (p = 0.8).
SP-RAPN can be safely implemented in a Center with an established MP-RAPN program. Despite being early in the SP-RAPN experience, key surgical outcomes are not compromised. While offering comparable perioperative and short-term functional outcomes, SP-RAPN can translate into faster recovery and shorter LOS, paving the way for outpatient robotic surgery.
本研究旨在比较单孔（SP）与多孔（MP）机器人辅助部分肾切除术（RAPN）的关键结局。
对2021年1月至2023年8月在本机构接受SP-RAPN或MP-RAPN的患者的前瞻性收集数据库进行回顾性分析。为调整潜在的术前基线混杂因素，进行了1:1倾向评分匹配分析（PSMa）。主要终点是比较两组的围手术期结局。次要终点是比较匹配队列中“三连胜”结局（定义为手术切缘阴性、无高级别并发症且随访6个月时估算肾小球滤过率（eGFR）值变化（ΔeGFR）<10%）的达成情况。
PSMa后，30例SP病例与30例MP病例1:1匹配。在匹配队列中，SP和MP入路在手术时间、估计失血量、缺血时间、输血率、术中并发症、术后并发症及手术切缘阳性率方面无显著差异。接受SP-RAPN的患者中位住院时间较短[25（四分位间距：24.0 - 34.5）小时 vs 34（四分位间距：30.2 - 48.0）小时，p < 0.003]。16例（57%）SP患者和17例（63%）MP患者达成了“三连胜”结局（p = 0.8）。
SP-RAPN可在已开展MP-RAPN项目的中心安全实施。尽管SP-RAPN经验尚浅，但关键手术结局未受影响。在提供可比的围手术期和短期功能结局的同时，SP-RAPN可实现更快恢复和更短住院时间，为门诊机器人手术铺平道路。
