title: Comparison of the trifecta outcomes of robotic and open nephron-sparing surgeries performed in the robotic era of a single institution.
abstract: OBJECTIVE
  In this study we aimed to report a comparative analysis between open and robotic nephron sparing surgeries (NSS) from a single institutional database.
  
  
  METHODS
  Patients who have undergone NSS during the robotic era of our institution were included in this study. Open (n = 74) and robotic (n = 59) groups were compared regarding trifecta outcome. Trifecta was defined as; warm ischemia time (WIT) <25 min, negative surgical margins and the absence of perioperative complications.
  
  
  RESULTS
  A total of 57 (77 %) and 45 (76 %) patients in the open and robotic groups, respectively achieved the trifecta outcome. Overall trifecta rate was 77 % (n = 102/133). The only statistically significant difference between trifecta positive and trifecta negative patients was the length of hospitalization (LOH). Except LOH; none of the tested parameters were shown to be predictive of trifecta outcome on univariate and multivariate analyses. Concerning trifecta positive patients; those in the open surgery group had larger tumors with a higher degree of morphometric complexity and were hospitalized for a longer period of time. Additionally, operative duration was significantly higher in the robotic group.
  
  
  CONCLUSIONS
  In our cohort, no significant difference in achieving the trifecta outcome was reported after open and robotic NSS. Length of hospitalization was the only parameter that differed significantly between trifecta positive and trifecta negative patients. Surgical approach was not a significant predictor of simultaneous achievement of trifecta outcomes. Irrespective of the trifecta definition; larger and more complicated tumors were handled via open NSS.
authors.affiliation: Department of Urology, School of Medicine, Koc University, Istanbul, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Acar
authors.affiliation: Biomedical Engineering Institute, Boğaziçi University, Istanbul, Turkey.
authors.forename: Esin Öztürk
authors.initials: EÖ
authors.lastname: Işık
authors.affiliation: Department of Urology, VKF American Hospital, Istanbul, Turkey.
authors.forename: Tuna
authors.initials: T
authors.lastname: Mut
authors.affiliation: Department of Pathology, School of Medicine, Acibadem University, Istanbul, Turkey.
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Sağlıcan
authors.affiliation: Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey.
authors.forename: Aslıhan
authors.initials: A
authors.lastname: Onay
authors.affiliation: Department of Radiology, VKF American Hospital, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Vural
authors.affiliation: Department of Urology, VKF American Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Musaoğlu
authors.affiliation: Department of Urology, School of Medicine, Koc University, Istanbul, Turkey ; Department of Urology, VKF American Hospital, Istanbul, Turkey.
authors.forename: Tarık
authors.initials: T
authors.lastname: Esen
keywords: Kidney cancer; Nephron-sparing surgery; Robotics; Trifecta