Category: Laparoscopic/ Robotic: Other
Introduction & Objective : Trifecta is defined as negative surgical margins, warm ischemia time of < 20 minutes, and no perioperative complications after robot assisted partial nephrectomy (RAPN). In this study, we aim to analyze trifecta outcomes of patients underwent RAPN by a single surgeon.
Methods : Between March 2012 and January 2018, consecutive 40 patients who underwent RAPN by the single surgeon were included in this study. Patients' perioperative outcomes were collected prospectively and complications were graded based on the modified Clavien-Dindo classification system.
Median R.E.N.A.L nephrometry score and tumor size were 6 (4-11, ± 1,8) and 38 (14-85, ±14) millimeters, respectively. Of 40 patients, 32 were cT1a, 7 were cT1b and one patient was cT2a. RAPN was successfully performed in all but one patient. The one had to be converted to radical robotic nephrectomy after two positive frozen section answers from base samples. Open conversion was not required in any patients. Median operation time was 180 (90-240, ±44) minutes. Warm ischemia (WI) was done only by selective segmental renal control in 35 and, by main renal artery control in 3 patients. Off clamp technique was used in only 2 patients. Early unclamping technique was also used to limit warm ischemia time (WIT) in all but 3 patients. Median WIT was 16 min (6-31; ±7) minutes. Although WIT was longer than 20 minutes in 7 patients segmental artery control was used in all. Median estimated blood loss was (10-700, ±52) milliliters. Four Clavien greater than 1 complications were observed, namely, 2 postoperative bleeding necessitating blood transfusions, one pneumothorax requiring chest tube, and the urinoma requiring percutaneous drainage. Positive surgical margin reported in one on the final pathology. As a result, trifecta is achieved in 35 of the 39 patients (%89).
Conclusions : RAPN seems to be safe and effective method for treatment of T1 renal tumors. High trifecta rates can be achieved even by low volume surgeons.
Istanbul Bilim University, Medical Faculty, Department of Uroloji
Istanbul, Istanbul, Turkey
Professor of Urology
İstanbul Bilim Üniversite, İstanbul, Turkey.
Istanbul, Istanbul, Turkey
1983-1990 M.D., Marmara Medical Faculty, Istanbul
1992-1997 Urology Residency, Cerrahpasa Medical School, University of Istanbul
1997-2007 Staff Urologist, Metropolitan Florence Nightingale Hospital, Istanbul
2007- 2010 Assistant Professor of Urology, Istanbul Bilim University
2011- 2014 Associate Professor of Urology, Istanbul Bilim University
2014 -2016 Director of Urooncology & Robotics Section, Liv Hospital, Istanbul
2016 - Professor of Urology, Istanbul Bilim University
RESEARCH & CLINICAL INTERESTS
1. Robotic Urooncologic Surgery
2. Laparoscopy and Minimally Invasive Surgery
3. Endourology- Urinary stone treatment (URS and PCNL)
Written Book Chapters: 7
Articles in peer reviewed international journals: 22
Articles in Turkish journals: 16
Presentations in international meetings: 52
Presentations in national meetings: 73