title: R-LESS partial nephrectomy trifecta outcome is inferior to multiport robotic partial nephrectomy: comparative analysis.
abstract: BACKGROUND
  Trifecta achievement in partial nephrectomy (PN) is defined as the combination of warm ischemia time ≤ 20 min, negative surgical margins, and no surgical complications.
  
  
  OBJECTIVE
  To compare trifecta achievement between robotic, laparoendoscopic, single-site (R-LESS) PN and multiport robotic PN (RPN).
  
  
  METHODS
  Data from 167 patients who underwent RPN from 2006 to 2012 were retrospectively analyzed.
  
  
  METHODS
  Primary outcome measurement was trifecta achievement; secondary outcome was the perioperative and postoperative comparison between groups. The measurements were estimated and analyzed with SPSS v.18 using univariable, multivariable, and subgroup analyses.
  
  
  CONCLUSIONS
  Eighty-nine patients were treated with RPN and 78 were treated with R-LESS PN. Baseline characteristics of both groups were similar. Trifecta was achieved in 38 patients (42.7%) in the multiport RPN group and 20 patients (25.6%) in the R-LESS PN group (p=0.021). Patients in the R-LESS PN group had longer mean operative time, warm ischemia time, and increased estimated glomerular filtration rate (eGFR) percentage change. No significant differences were found between the two groups in days of hospitalization, blood loss, postoperative eGFR, positive surgical margins, and surgical complications. Patients with increased PADUA and RENAL scores, infiltration of the collecting system, and renal sinus involvement had an increased probability of not achieving the trifecta. In regression analysis, the type of procedure and the tumor size could predict trifecta accomplishment (p=0.019 and 0.043, respectively). The retrospective study, the low number of series, and the controversial definition of trifecta were the main limitations.
  
  
  CONCLUSIONS
  The trifecta was achieved in significantly more patients who underwent multiport RPN than those who underwent R-LESS PN. R-LESS PN could be an alternative option for patients with decreased tumor size, low PADUA and RENAL scores, and without renal sinus or collecting system involvement.
  
  
  RESULTS
  In this study, we looked at the outcomes of patients who had undergone robotic partial nephrectomy. We found that conventional robotic partial nephrectomy is superior to R-LESS partial nephrectomy with regard to the accomplishment of negative margins, reduced warm ischemia time, and minimal surgical complications.
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; Department of Urology, General Hospital of Nikaia 'St. Panteleimon', Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Komninos
authors.affiliation: Department of Urology, Chuncheon Sacred Hospital, Hallym Medical College, Chuncheon, South Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Shin
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Patrick
authors.initials: P
authors.lastname: Tuliao
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Yoon
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyo Chul
authors.initials: KC
authors.lastname: Koo
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Chien-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sang Woon
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ha
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.affiliation: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: khrha@yuhs.ac.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D047368:Tumor Burden; D052096:Warm Ischemia
keywords: Laparoendoscopic single-site; Partial nephrectomy; Renal cell carcinoma; Robotic surgery