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Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC)

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Abstract

Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to compare outcomes of two commonly described incisions for retroperitoneal SP RPN: lateral flank approach (LFA) and low anterior access (LAA). We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 to 2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t test, Fisher exact test, and Mann–Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. Overall, there were no significant differences in baseline characteristics between the two groups. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). In the bivariate analysis, there were no statistically significant differences in ischemia time, estimated blood loss, or complication rates between the groups. However, the LAA group had longer operative times (101 vs. 134 min, p < 0.001), but was more likely to undergo a same-day discharge (p < 0.001). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005), but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Both LFA and LAA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes. This early data suggests the LAA is more versatile for varying tumor locations; however, larger cohort studies are needed to ascertain whether there is an overall difference in patient recovery.

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No data sets were generated or analysed during the current study.

References

  1. Network NCC. Kidney Cancer (Version.1.2024) https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf.

  2. Razdan S, Okhawere KE, Ucpinar B, Saini I, Deluxe A, Abaza R et al (2023) The state of robotic partial nephrectomy: operative, functional, and oncological outcomes from a robust multi-institution collaborative. Urology 173:92–97

    Article  PubMed  Google Scholar 

  3. Glaser ZA, Burns ZR, Fang AM, Saidian A, Magi-Galluzzi C, Nix JW et al (2022) Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements. J Robot Surg 16(3):695–703

    Article  PubMed  Google Scholar 

  4. Harrison R, Ahmed M, Billah M, Sheckley F, Lulla T, Caviasco C et al (2023) Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robot Surg 17(1):223–231

    PubMed  Google Scholar 

  5. Bang S, Shin D, Moon HW, Cho HJ, Ha US, Lee JY et al (2023) Comparison of transperitoneal and retroperitoneal partial nephrectomy with single-port robot. J Endourol 37(5):551–556

    Article  PubMed  Google Scholar 

  6. Rich JM, Okhawere KE, Nguyen C, Ucpinar B, Zuluaga L, Razdan S et al (2023) Transperitoneal versus retroperitoneal single-port robotic-assisted partial nephrectomy: an analysis from the single port advanced research consortium. Eur Urol Focus 9(6):1059–1064

    Article  PubMed  Google Scholar 

  7. Socarrás MR, Elbers JR, Rivas JG, Autran AM, Esperto F, Tortolero L et al (2021) Retroperitoneal robot-assisted partial nephrectomy (rrapn): surgical technique and review. Curr Urol Rep 22(6):33

    Article  PubMed  Google Scholar 

  8. Harke NN, Darr C, Radtke JP, von Ostau N, Schiefelbein F, Eraky A et al (2021) Retroperitoneal versus transperitoneal robotic partial nephrectomy: a multicenter matched-pair analysis. Eur Urol Focus 7(6):1363–1370

    Article  PubMed  Google Scholar 

  9. Carbonara U, Crocerossa F, Campi R, Veccia A, Cacciamani GE, Amparore D et al (2022) Retroperitoneal robot-assisted partial nephrectomy: a systematic review and pooled analysis of comparative outcomes. Eur urol open sci 40:27–37

    Article  PubMed  PubMed Central  Google Scholar 

  10. Maurice MJ, Ramirez D, Kaouk JH (2017) Robotic laparoendoscopic single-site retroperitioneal renal surgery: initial investigation of a purpose-built single-port surgical system. Eur Urol 71(4):643–647

    Article  PubMed  Google Scholar 

  11. Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S (2023) Simplifying retroperitoneal robotic single-port surgery: novel supine anterior retroperitoneal access. Eur Urol 84(2):223–228

    Article  PubMed  Google Scholar 

  12. Tameze Y, Low YH (2022) Outpatient robotic surgery: considerations for the anesthesiologist. Adv Anesth 40(1):15–32

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bhalodia VM, Sestokas AK, Tomak PR, Schwartz DM (2008) Transcranial electric motor evoked potential detection of compressional peroneal nerve injury in the lateral decubitus position. J Clin Monit Comput 22(4):319–326

    Article  PubMed  Google Scholar 

  14. Mills JT, Burris MB, Warburton DJ, Conaway MR, Schenkman NS, Krupski TL (2013) Positioning injuries associated with robotic assisted urological surgery. J Urol 190(2):580–584

    Article  PubMed  Google Scholar 

  15. Shaikh S, Nabi G, McClinton S (2006) Risk factors and prevention of rhabdomyolysis after laparoscopic nephrectomy. BJU Int 98(5):960–962

    Article  PubMed  Google Scholar 

  16. Yanagi M, Hamasaki T, Morita K, Takeda H, Akatsuka J, Endo Y et al (2022) Rhabdomyolysis after retroperitoneal laparoscopic radical nephrectomy in the lateral decubitus position. J Nippon Med Sch (Nippon Ika Daigaku zasshi). 89(4):466–468

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA

    Shirin Razdan, Kennedy E. Okhawere, Laura Zuluaga, Indu Saini, Burak Ucpinar & Ketan K. Badani

  2. Department of Urology, University of Illinois, Chicago, IL, USA

    Ruben Calvo Sauer & Simone Crivellaro

  3. Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Nicholas Soputro & J. H. Kaouk

  4. Hackensack University Medical Center, Hackensack, NJ, USA

    Mutahar Ahmed & Michael D. Stifelman

Authors
  1. Shirin Razdan
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  2. Kennedy E. Okhawere
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  3. Laura Zuluaga
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  4. Indu Saini
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  5. Burak Ucpinar
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  6. Ruben Calvo Sauer
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  7. Nicholas Soputro
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  8. Simone Crivellaro
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  9. J. H. Kaouk
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  10. Mutahar Ahmed
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  11. Michael D. Stifelman
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  12. Ketan K. Badani
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Contributions

All authors contributed to study concept and design. Manuscript writing was performed by Dr. Shirin Razdan. Data analysis and statistics were performed by Dr. Kennedy E. Okhawere. All authors commented on prior versions of the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Shirin Razdan.

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Razdan, S., Okhawere, K.E., Zuluaga, L. et al. Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC). J Robotic Surg 18, 216 (2024). https://doi.org/10.1007/s11701-024-01969-9

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  • DOI: https://doi.org/10.1007/s11701-024-01969-9

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