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240 Robotic Partial Nephrectomy Cases by A Single Surgeon
Kyle T. Finnegan, B.S.1, Halil Kiziloz, M.D.2, Stuart S. Kesler, M.D.1, Anoop M. Meraney, M.D.1, Steven J. Shichman, M.D.1.
1Hartford Hospital, Hartford, CT, USA, 2Hacettepe Hospital, Ankara, Turkey.

BACKGROUND:
In recent years, the utilization of robotic partial nephrectomy (RPN) has increased and offers an additional option for the treatment of renal tumors. In this study, we analyze a single surgeon's first 240 RPN's with focus on peri-operative outcomes over time.
METHODS:
A single surgeon performed 240 RPN's from 10/2007-10/2011. Peri-operative and post-operative outcomes were analyzed and compared between three groups: Group 1 (first 80 cases: 10/07-3/09), Group II (second 80 cases: 3/09-5/10) and Group III (third 80 cases: 6/10-10/11). Evolutions in surgical technique include alterations to the trocar placement, placing fewer sutures while clamped, adding more sutures after the release of clamps, and cutting sutures and removing needles after vascular occlusion clamps are removed.
RESULTS:
Age at surgery, total operative time, estimated blood loss, and length of hospital stay were comparable between the three groups. Significant differences were seen in the following parameters: BMI [28.08 vs. 30.19 vs. 29.82 k/m2 (p=0.03)], tumor size [2.5 vs. 3.2 vs. 3.1 cm (p=0.001)], and most clinically significant, the decline in WIT (warm ischemic time) [30.39 vs. 22.53 vs. 17.67 mins (p<0.001)] comparing groups I, II, and III. 15 complications occurred in group I (11 Clavien-grade I), 8 in group II (6 Clavien-grade I) and 6 in group III (4 Clavien-grade I). There were 3 conversions in group I (1-Laparoscopic Partial Nephrectomy (LPN), 2-open partial nephrectomy (OPN)), 4 conversions in group II (3-OPN and 1-LPN) and 4 conversions in group III (2-LRN, 1-OPN, and 1-Robotic Radical Nephrectomy). Average decrease in eGFR measured 4-months post-operatively was also not significantly different between the three groups.
CONCLUSIONS:
Increased experience and slowly evolving surgical techniques have resulted in a significant decrease in WITs and complication rate associated with RPN. Improved peri-operative outcomes are still achieved as the RPN series progresses despite performing procedures with more complexity, as shown by the increase in patient BMI and tumor size.


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