Elimination of surgical drains following robotic-assisted partial nephrectomy
Tóm tắt
To prospectively evaluate outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of surgical drains. 100 consecutive drainless RAPN performed by a single surgeon were analyzed following a previously published quantitative assessment of drain creatinine/serum creatinine ratios. This cohort was compared to 100 preceding RAPN with drains. Variables analyzed included pre-operative patient/tumor characteristics and post-operative outcomes including post-operative estimated glomerular filtration rate (eGFR), length of hospital stay (LOS), and complications. There was no significant difference in median patient age, sex, body mass index, ASA score, or pre-operative eGFR between the two groups. The preceding 100 patients with drains did have larger median renal size (3.5 vs 2.6 cm, p < 0.001), higher median RENAL scores (9 vs 8, p < 0.001), and longer warm ischemia time (21 vs 18 min, p = 0.004). Patients without drains had shorter median LOS (2.0 days vs 3.0 days, p < 0.001), fewer Grade III or higher post-operative complications (4% vs 10%, p = 0.007), and no difference in 1 month percent change in eGFR (− 13% vs − 11%, p = 0.84). After adjusting for confounding variables there was no difference in LOS (OR 1.50, p = 0.31), Grade III–V complications (OR 1.49, p = 0.63), or 1 month percent change in eGFR (OR 2.3, p = 0.41) between the two groups. One patient in the drainless group required a post-operative drain for a urine leak diagnosed 10 days following RAPN. Omission of drains is safe in RAPN and does not appear to offer a clinical advantage.
Tài liệu tham khảo
Luciani LG, Chiodini S, Mattevi D, Cai T, Puglisi M, Mantovani W, Malossini (2017) Robotic-assisted partial nephrectomy provides better operative outcomes as compared to the laparoscopic and open approaches: results from a prospective cohort study. J Robot Surg 11:333–339
Potretzke AM, Knight BA, Zargar H et al (2016) Urinary fistula after robot-assisted partial nephrectomy: a multicentre analysis of 1791 patients. BJU Int 117:131–137. https://doi.org/10.1111/bju.13249
Kriegmair MC, Mandel P, Krombach P, Dönmez H, John A, Häcker A, Michel MS (2016) Drain placement can safely be omitted for open partial nephrectomy: results from a prospective randomized trial. Int J Urol 23:390–394. https://doi.org/10.1111/iju.13063
Williams RD, Snowden C, Thiel DD (2017) Assessment of perioperative variables that predict the need for surgical drains following robotic partial nephrectomy utilizing quantitative drain creatinine analysis. J Laparoendosc Adv Surg Tech 27:43–47. https://doi.org/10.1089/lap.2016.0417
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470. https://doi.org/10.7326/0003-4819-130-6-199903160-00002
Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526
Taylor AS, Lee B, Rawal B, Thiel DD (2015) Impact of fellowship training on robotic-assisted laparoscopic partial nephrectomy: Benchmarking perioperative safety and outcomes. J Robot Surg 9:125–130. https://doi.org/10.1007/s11701-015-0498-z
Bhayani SB, Figenshau RS (2008) The Washington University Renorrhaphy for robotic partial nephrectomy: a detailed description of the technique displayed at the 2008 World Robotic Urologic Symposium. J Robot Surg 2:139–140. https://doi.org/10.1007/s11701-008-0096-4
Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186:411–416. https://doi.org/10.1016/j.juro.2011.03.151
Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol 189:823–827. https://doi.org/10.1016/j.juro.2012.08.236
Williams RD, Snowden C, Frank R, Thiel DD (2017) Has sliding-clip renorrhaphy eliminated the need for collecting system repair during robot-assisted partial nephrectomy? J Endourol 31:289–294. https://doi.org/10.1089/end.2016.0562
Khandwala YS, Jeong IG, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI (2017) The impact of surgeon volume on perioperative outcomes and costs for patients receiving robotic partial nephrectomy. J Endourol 31:851–857. https://doi.org/10.1089/end.2017.0207