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Robot-assisted partial nephrectomy in morbidly obese patients: a VCQI database study

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Abstract

To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with morbid obesity (body mass index (BMI > 40 kg/m2)) and non-obese patients. Using the Vattikuti Collective quality initiative (VCQI) database for RAPN, data for morbidly obese and non-obese patients was obtained. Propensity scores were calculated for two treatment groups (morbidly obese vs. non-obese) for the following variables i.e. age, sex, tumor size, RNS, surgical access (retroperitoneal/transperitoneal) and estimated glomerular filtration rate (eGFR) to ensure comparability. The primary outcome for the study was comparison of trifecta between the two groups. In this study, 158 morbidly obese patients were matched with 158 non-obese patients undergoing RAPN. Two groups matched well for age, sex, tumor size, eGFR and RNS. There was no difference between two groups for ischemia time, blood loss, blood transfusion, conversion to radical nephrectomy, length of stay, intraoperative and postoperative complications. Operative time was longer in morbidly obese patients (median 210 min vs. 120 min, p = 0.000). On pathological analysis, malignant tumors were more likely in the morbidly obese group (83.1% vs.73.4%, p = 0.018). Trifecta outcomes were comparable between the two groups (60.1% vs. 63.3%, p = 0.563). The Median duration of follow-up was 12 months (1–96 months). The morbidly obese group had significantly higher day one creatinine (1.25 ± 0.7 vs. 1.07 ± 0.37, p = 0.001) and significantly lower day one eGFR (62.1 ± 19 vs. 69.2 ± 21, p = 0.018). However, there was no difference between the two groups for the last follow-up creatinine and eGFR. RAPN in morbidly obese patients is associated with equivalent perioperative outcomes compared to non-obese patients.

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Data Availability

Corresponding author had access to all the data and is available to genuine authors on request.

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Acknowledgements

Vattikuti Foundation for providing data.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urologic Oncology, Medanta The Medicity, Gurgaon, India

    Gopal Sharma, Gurpremjit Singh, Puneet Ahluwalia & Gagan Gautam

  2. Faculty of Life Sciences and Medicine, King’s College, King’s Health Partners, London, UK

    Prokar Dasgupta

  3. Guy’s and St. Thomas’ NHS Foundation Trust, Guys and St Thomas’ Hospital, London, UK

    Benjamin J. Challacombe

  4. Vattikuti Foundation, Detroit, MI, USA

    Mahendra Bhandari

  5. Medanta the Medicity, The Medicity Hospital, Gurugram, New Delhi, India

    Rajesh Ahlawat

  6. Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

    Sudhir Rawal

  7. Humanitas Research Hospital, Rozzano, MI, Italy

    Nicolo M. Buffi

  8. Chennai Urology and Robotics Institute, Apollo Hospitals, Greams Lane, Chennai, India

    Sivaraman Ananth

  9. Swedish Medical Center, Seattle, WA, USA

    James R. Porter

  10. Henry Ford Hospital, Detroit, MI, USA

    Craig Rogers

  11. ORSI Academy, Melle, Belgium

    Alexandre Mottrie

  12. Central Ohio Urology Group and Mount Carmel, St. Ann’s Hospital, Columbus, OH, USA

    Ronney Abaza

  13. Yonsei University Health System, Seoul, South Korea

    Khoon Ho Rha

  14. Peter MacCallum Cancer Centre, Peter MacCallum Hospital, Royal Melbourne Clinical School, University of Melbourne, Melbourne, Australia

    Daniel Moon

  15. Kokilaben Dhirubhai Ambani Hospital, Mumbai, India

    Thyavihally B. Yuvaraja

  16. University of Miami Health System, Miami, FL, USA

    Dipen J. Parekh

  17. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy

    Umberto Capitanio

  18. Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal

    Kris K. Maes

  19. San Luigi Gonzaga Hospital of Orbassano, Turin, Italy

    Francesco Porpiglia

  20. Department of Urology, Altuzinade Hospital, Acıbadem M.A., Aydınlar University, Istanbul, Turkey

    Levent Turkeri

Authors
  1. Gopal Sharma
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  2. Gurpremjit Singh
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  3. Puneet Ahluwalia
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  4. Prokar Dasgupta
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  5. Benjamin J. Challacombe
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  6. Mahendra Bhandari
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  7. Rajesh Ahlawat
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  8. Sudhir Rawal
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  9. Nicolo M. Buffi
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  10. Sivaraman Ananth
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  11. James R. Porter
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  12. Craig Rogers
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  13. Alexandre Mottrie
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  14. Ronney Abaza
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  15. Khoon Ho Rha
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  16. Daniel Moon
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  17. Thyavihally B. Yuvaraja
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  18. Dipen J. Parekh
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  19. Umberto Capitanio
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  20. Kris K. Maes
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  21. Francesco Porpiglia
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  22. Levent Turkeri
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  23. Gagan Gautam
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Contributions

Study concept and design: GS, GPS Data acquisition: PD, BC, MB, RA, SR, NMB, SA, JRP, CR, AM, RA, KHR, DM, TBY, DJP, UC, KKM, FP, LT Data analysis: GS Drafting of the manuscript: GS, GPS Critical revision of the manuscript: PA, PD, BC, MB, RA, SR, NMB, SA, JRP, CR, AM, RA, KHR, DM, TBY, DJP, UC, KKM, FP, LT, GG. All authors reviewed the manuscript.

Corresponding author

Correspondence to Gopal Sharma.

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Conflict of interest

Ronney Abaza is a speaker for Intuitive surgical, Conmed Inc and VTI. Benjamin J Challacombe, Kris K Maes, Rajesh Ahlawat and Gagan Gautam are proctors for Intuitive surgical. Other authors report no conflict of interests.

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Sharma, G., Singh, G., Ahluwalia, P. et al. Robot-assisted partial nephrectomy in morbidly obese patients: a VCQI database study. J Robotic Surg 17, 2141–2147 (2023). https://doi.org/10.1007/s11701-023-01627-6

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  • DOI: https://doi.org/10.1007/s11701-023-01627-6

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