Faria Eliney Ferreira, Moschovas Marcio Covas, Vaz Carlos, Pompeo Alexandre, Santos Alexandre, Stievano Alexandre, Berger Andre, Carneiro Arie, Dourado Aurus, Colombo Jose Roberto, Passerotti Carlo, Andreoni Cassio, Fraga Clovis, Guglielmetti Giuliano, Lemos Gustavo, Guimarães Gustavo, Nogueira Lucas, Rocha Marcos, Melo Pablo, Arantes Paulo, Romanelli Pedro, Tourinho Rafael, Nishimoto Ricardo, Machado Roberto, Reis Rodolfo, Frota Rodrigo, Guida Romulo, Dubeux Victor, Gualberto Rodrigo, Tobias-Machado Marcos
Urology Department, Hospital Felício Rocho, Belo, Horizonte, Brazil.
Urology Department, Advent Health, Orlando, FL, United States.
Front Urol. 2023 Feb 3;3:1119494. doi: 10.3389/fruro.2023.1119494. eCollection 2023.
Robotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus.
We implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed.
We divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic.
RAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors' assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.
机器人辅助部分肾切除术（RAPN）已成为治疗小肾肿块的金标准方法。然而，与该方法相关的众多技术挑战和概念仍在讨论中，不同中心的外科医生尚未达成共识。我们针对RAPN开展了一项包含多个主题的在线问卷调查，并从巴西的转诊中心挑选了手术量较大的外科医生以达成共识。
我们对29位基于手术专业知识和分析已发表文献能力而选出的专家进行了在线共识调查。基于收集到的文献和现行指南（NCCN、AUA和EAU），我们创建了一份包含131个问题的问卷并分发给所有参与者。陈述和德尔菲技术设计被整合在一轮问题中。对答案进行审核，70%的一致性被视为达成共识，并形成了一份带有建议的最终手稿。
我们将结果分为25个子主题，涵盖问卷的所有问题和讨论，包括术前准备、手术技术、病理分析、技术应用和具有挑战性的病例。文献中有些领域的数据有限，每个主题都对这些潜在局限性进行了阐述和讨论。
在机器人手术中心，RAPN是肾肿块的标准手术治疗方法。在本研究的重要主题中，我们建议首次进行RAPN手术时始终在带教老师的协助下进行，使用高质量的影像学检查进行术前规划，尽量减少肾实质的切除量，并在减少肾实质缺血的同时实现适当的止血缝合。
