Category: Laparoscopic/ Robotic: Other
Introduction & Objective : To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve.
305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) lab values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results.
Results : Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs 192 minutes, P<0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, though this was not statistically significant (median, 0.2 vs. 0.1 mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes.
Conclusions : APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.
Ashley Shumate– Resident, Department of Urology, Mayo Clinic, Jacksonville, Florida
Grayson Roth– Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
Colleen Thomas– Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
Kaitlynn Custer– Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
David Thiel– Department of Urology, Mayo Clinic, Jacksonville, Florida
Division of Biomedical Statistics and Informatics, Mayo Clinic
Department of Health Sciences Research, Mayo Clinic