title: The role of R.E.N.A.L. nephrometry score in the era of robot-assisted partial nephrectomy.
abstract: OBJECTIVE
  We studied the role of the R.E.N.A.L. nephrometry score (NS) in predicting surgical outcomes in a series of robot-assisted partial nephrectomy (RAPN).
  
  
  METHODS
  Of 99 cases of minimally invasive partial nephrectomy performed by a single surgeon from 2003 to 2011, 83 were performed with robotic assistance. A trained physician investigator applied the NS to these 83 cases using the preoperative CT scans. Forty-two of these were reviewed by a urology resident to eliminate interobserver variation. Tumors were categorized into noncomplex (NS 4-6) or complex (NS 7-12) tumors, and perioperative outcomes were compared. Outcomes were also compared by each component of the NS. Perioperative outcomes were analyzed using chi-square tests and Mann-Whitney/Kruskal-Wallis tests. Univariate regression was used to analyze trends between nephrometry and outcomes.
  
  
  RESULTS
  Strong correlation was found between the two sets of NS (Spearman correlational coefficient 0.814, P<0.001). Comparing between noncomplex and complex tumors, statistical differences were found in operative time (181 min vs 215 min, P=0.028) and ischemia time (21 min vs 24 min, P=0.006). Complication rates, blood loss, conversion rate, and decrease in glomerular filtration rate were similar in both groups. On univariate regression analysis, only warm ischemia time showed a significant trend with the overall NS (P=0.007) and the location score (P=0.031).
  
  
  CONCLUSIONS
  A high NS was not associated with clinically worse outcomes during RAPN. Such renal tumors can still be excised safely with robotic assistance without adverse long-term effects.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Keng-Siang
authors.initials: KS
authors.lastname: Png
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Bahler
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Milgrom
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lucas
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011182:Postoperative Care; D012371:Robotics; D016896:Treatment Outcome