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3D-Image guided robotic-assisted partial nephrectomy: a multi-institutional propensity score-matched analysis (UroCCR study 51)

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Abstract

Purpose

Robot-assisted partial nephrectomy (RAPN) is a difficult procedure with risk of significant perioperative complications. The objective was to evaluate the impact of preoperative planning and intraoperative guidance with 3D model reconstructions on perioperative outcomes of RAPN.

Methods

We conducted a retrospective analysis of all patients who underwent RAPN for kidney tumor by three high-volume expert surgeons from academic centers. Clinical data were collected prospectively after written consent into the French kidney cancer network database UroCCR (CNIL-DR 2013-206; NCT03293563). Our cohort was divided into two groups: 3D-Image guided RAPN group (3D-IGRAPN) and control group. A propensity score according to age, pre-operative renal function and RENAL tumor complexity score was used. Both surgical techniques were compared in terms of perioperative outcomes.

Results

The initial study cohort included 230 3D-IGRAPN and 415 control RAPN. Before propensity-score matching, patients in the 3D-IGRAPN group had a larger tumor (4.3 cm vs. 3.5 cm, P < 0.001) and higher RENAL complexity score (9 vs. 8, P < 0.001). Following propensity-score matching, there were 157 patients in both groups. The rate of major complications was lower for patients in the 3D-IGRAPN group (3.8% vs. 9.5%, P = 0.04). The median percentage of eGFR variation recorded at first follow-up was lower in the 3D-IGRAPN group (− 5.6% vs. − 10.5%, P = 0.002). The trifecta achievement rate was higher in the 3D-IGRAPN group (55.7% vs. 45.1%; P = 0.005).

Conclusion

Three-dimensional kidney reconstructions use for pre-operative planning and intraoperative surgical guidance lowers the risk of complications and improve perioperative clinical outcomes of RAPN.

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Authors and Affiliations

  1. Department of Urology, Bordeaux University Hospital, Bordeaux, France

    Clément Michiels, Astrid Boulenger de Hauteclocque, Mélanie Percot, Hélène Simeon, Laure Dupitout, Henri Bensadoun, Grégoire Capon, Eric Alezra, Vincent Estrade, Franck Bladou, Grégoire Robert, Jean-Marie Ferriere & Jean-Christophe Bernhard

  2. Department of Urology, Rennes University Hospital, Rennes, France

    Zine-Eddine Khene & Karim Bensalah

  3. Department of Urology, Toulouse University Hospital, Toulouse, France

    Thomas Prudhomme & Nicolas Doumerc

  4. Department of Radiology, Bordeaux University Hospital, Bordeaux, France

    François H. Cornelis & Nicolas Grenier

  5. Department of Radiology, Tenon Hospital, APHP, Paris, France

    François H. Cornelis

Authors
  1. Clément Michiels
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  2. Zine-Eddine Khene
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  3. Thomas Prudhomme
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  14. Grégoire Robert
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  19. Jean-Christophe Bernhard
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Contributions

CM: protocol development, data management, data analysis, manuscript writing; ZEK: protocol development, data management, data analysis, manuscript editing; TP: data collection; ABH: data collection; FHC: protocol development; MP: data collection; HS: data collection; LD: data collection; HB: manuscript editing; GC: manuscript editing; EA: manuscript editing; VE: manuscript editing; FB: manuscript editing; GR: manuscript editing; JMF: manuscript editing; NG: protocol development; ND: project development, data collection, manuscript editing; KB: project development, data collection, manuscript editing; JCB: project development, data collection, manuscript editing.

Corresponding author

Correspondence to Clément Michiels.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Informed consent

Informed consent was collected for each patient which were all included into the French kidney cancer network database UroCCR (CNIL-DR 2013-206; NCT number 03293563).

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Michiels, C., Khene, ZE., Prudhomme, T. et al. 3D-Image guided robotic-assisted partial nephrectomy: a multi-institutional propensity score-matched analysis (UroCCR study 51). World J Urol 41, 303–313 (2023). https://doi.org/10.1007/s00345-021-03645-1

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