Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
World J Urol. 2024 Jul 3;42(1):387. doi: 10.1007/s00345-024-05096-w.
Single-Port Robot-Assisted Partial Nephrectomy (SP-RAPN) can be performed by transperitoneal and retroperitoneal approaches. However, there is a lack of surgical outcomes for novel Retroperitoneal Low Anterior Access (LAA) in SP-RAPN. The study compared outcomes of the standard approach (SA), considering transperitoneal (TP) and posterior retroperitoneal (RP) access vs LAA in SP-RAPN series.
102 consecutive patients underwent SP-RAPN between 2019 and 2023 at a tertiary referral robotic center were identified. Baseline characteristics, peri- and post-operative outcomes were collected. Patients were stratified according to surgical approach into standard (RP or TP) vs LAA and, subsequently, RP vs LAA. Multivariable logistic regression analysis was used to test the probability of the same-day discharge adjusting for comorbidity indexes.
Overall, 102 consecutive patients were included in this study (68 SA - 26 TP and 42 posterior RP vs 34 LAA). Median age was 60 (IQR 51.5-66) years and median BMI was 31 (IQR 26.3-37.6). No baseline differences were observed. LAA exhibited significantly shorter length of stay (LOS) (median 10 [IQR 8-12] vs 24 [IQR 12-30.2.] hours, p < .0001), reduced post-operative pain (p < .0001) and decreased narcotic use on 0-1 PO Day (p < .001) compared to SA and RP only. Multivariate analysis, adjusting for comorbidities, identified LAA as a strong predictor for Same-Day Discharge.
LAA is an effective approach as well as RP and TP, regardless of the renal mass location, whether it is anterior or posterior, upper/mid or lower pole, yielding favorable outcomes in LOS, post-operative pain and decreased narcotics use compared to SA in SP-RAPN.
单端口机器人辅助部分肾切除术（SP-RAPN）可通过经腹腔和后腹腔途径进行。然而，在 SP-RAPN 中，新型后腹腔低位前入路（LAA）的手术结果缺乏研究。本研究比较了标准入路（SA），考虑经腹腔（TP）和后腹腔（RP）入路与 SP-RAPN 系列中 LAA 的手术结果。
在一家三级转诊机器人中心，2019 年至 2023 年期间，共确定了 102 例连续接受 SP-RAPN 治疗的患者。收集了基线特征和围手术期及术后结果。根据手术方式将患者分为标准（RP 或 TP）与 LAA 以及 RP 与 LAA 两组，然后进行多变量逻辑回归分析，以测试调整合并症指数后当天出院的概率。
总体而言，本研究共纳入 102 例连续患者（68 例 SA-26 例 TP 和 42 例后 RP 与 34 例 LAA）。中位年龄为 60 岁（IQR 51.5-66 岁），中位 BMI 为 31（IQR 26.3-37.6）。两组间无基线差异。与 SA 和 RP 相比，LAA 的住院时间（LOS）明显更短（中位数 10 [IQR 8-12] vs 24 [IQR 12-30.2] 小时，p<0.0001），术后疼痛减轻（p<0.0001），术后 0-1 天的阿片类药物使用减少（p<0.001）。多变量分析，调整合并症后，LAA 是当天出院的强有力预测因素。
无论肾脏肿瘤位置在前、在后、在上/中极还是在下极，LAA 都是一种有效的方法，与 RP 和 TP 一样，在 SP-RAPN 中，与 SA 相比，LAA 可获得更有利的 LOS、术后疼痛和减少阿片类药物使用的结果。
