Laparoscopy and RoboticsPerioperative Complications of Robot-assisted Partial Nephrectomy: Analysis of 886 Patients at 5 United States Centers
Section snippets
Materials and Methods
With Institutional Review Board approval, a retrospective review of deidentified, consented, prospectively maintained databases at 5 US centers was performed evaluating all patients who underwent RAPN from June 2007 to November 2011. Data for 886 patients were collected. Preoperative computed tomography or magnetic resonance imaging demonstrated contrast-enhancing renal masses in all patients. All treatment options, including surveillance, were discussed with patients. Indications for RAPN and
Results
Table 1 summarizes patient demographics, tumor characteristics, and perioperative outcomes. Of the 886 patients, intraoperative complications occurred in 23 (2.6%), and 139 postoperative complications occurred in 115 patients (13.0%), for a total complication rate of 15.6%. Postoperative complications classified by Clavien grade and organ system are listed in Table 2. Intraoperative complications occurred in 2.3%, 2.7%, and 8.2% of procedures performed for tumors with NSS scores 4 to 6, 7 to 9,
Comment
Early reports indicate that RAPN has a relatively shorter learning curve than LPN7, 8 and, hence, may facilitate the use of minimally invasive nephron-sparing surgery. Numerous studies have now described the utility of RAPN in managing large and complex renal masses, including endophytic, central, and hilar lesions.9, 11, 12, 20 Furthermore, multiple series have demonstrated equivalent preliminary oncologic and functional outcomes between RAPN and LPN.9, 12, 21
Complication rates can be used to
Conclusions
Complication rates in this large multicenter study of RAPN appear to be acceptable and comparable to other nephron-sparing modalities. Most complications (77.0%) are classified as Clavien 1 and 2 and can be managed conservatively. The NSS is a valid predictor of complication rates in the current series. The most common complication of RAPN is hemorrhage; most patients with postoperative hemorrhage can be managed conservatively. Conversion to open or laparoscopic PN or to RN is uncommon. Despite
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Financial Disclosure: Jihad H. Kaouk is a consultant for Intuitive Surgical and Ethicon. Craig G. Rogers is a speaker for Intuitive Surgical and Ethicon Biosurgery and is a consultant for Vascular Technology and Hitachi-Aloka Ultrasound. Michael D. Stifelman is a speaker for Intuitive Surgical and Baxter and is a consultant for Vascular Technology. Sam B. Bhayani is a consultant for Baxter. The other authors declare that they have no relevant financial interests.