Purpose: To compare perioperative and trifecta outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic assisted laparoscopic partial nephrectomy (RPN) in patients with small renal mass at Ramathibodi Hospital, and to determine predictive factors in connection with trifecta. Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy by eight experienced surgeons from January 2009 to December 2018. Baseline preoperative characteristics, postoperative and trifecta outcomes of the three treatment modalities were compared and analyzed. Univariate analysis was performed to determine predictive factors for trifecta achievement. Results: A total of 70 patients had complete data available. 18 OPN, 11 LPN and 41 RPN cases were identified and reviewed. All preoperative and perioperative parameters were similar, except for operative time, which was significantly shorter in the OPN group compared with those undergoing LPN and RPN (135 vs 189 and 225 min, respectively; p-value = 0.001). Of these 70 patients, 59 were deemed eligible for and included in trifecta analysis, which revealed similar trifecta outcomes (64.29.%, 45.45%, and 64.71% in the OPN, LPN, and RPN groups, respectively; p-value = 0.388). Univariate analysis showed that length of hospital stay was a negative associated factor for trifecta achievement (p-value = 0.007, 95% CI =0.619 (0.44-0.88)).Conclusion: Although OPN displayed the shortest operative time, the trifecta achievement rate was not significantly different among the three groups. The sole parameter, which was negatively associated with trifecta outcome achievement, was the length of hospital stay.

Objective: To assess the long-term ureteric-stump outcomes and complications among patients who had undergone upper-pole heminephrectomies of double collecting systems. Materials and Methods: The medical records of patients who had undergone upper-pole heminephrectomies for non-functioning upper moiety between January 2007 and December 2018 were retrospectively reviewed. Data regarding clinical presentations, age during surgery, operative details, and complications were recorded. Results: Ten patients were included in the study, nine were children and one was an adult. Double collecting systems with ureteroceles were found in four patients, ectopic ureters being found in six. Nine patients had undergone open heminephrectomies, whereas one patient had undergone robot-assisted surgery. Median age at heminephrectomy was one year old (range: 0.58 to 74 years). Median follow-up time was 81.1 months (range: 40.6 to 140.1 months). Median length of hospital stay was seven days (range: 5 to 22 days). Three patients (30%) had stump complications, including stump abscess in one patient, persistent vaginal discharge in another, and a prolapsed ureterocele in the third. Additional interventions were required in two patients, comprising percutaneous drainage of a stump abscess and the excision of a prolapsed ureterocele. Conclusions: Our study found three-cases of long-term complications, with only a single patient requiring distal ureteric stump excision. These findings were similar to another study which also showed that the majority of patients did not require stump excision. Other complications were minor and could be treated by local anesthetic intervention for stump abscess and oral antibiotic for UTI. Therefore, upper pole heminephrectomy with subtotal ureterectomy was the appropriate option for in-patients with double collecting system and non-functioning upper moiety.

Purpose To compare perioperative and trifecta outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted laparoscopic partial nephrectomy (RPN) in patients with small renal mass at Ramathibodi Hospital, and to determine predictive factors in connection with trifecta. Methods We retrospectively reviewed 141 patients who underwent partial nephrectomy by eight experienced surgeons from January 2009 to December 2018. Baseline preoperative characteristics, postoperative and trifecta outcomes of the three treatment modalities were compared and analyzed. Univariate analysis was performed to determine predictive factors for trifecta achievement. Results A total of 70 patients had complete data available. Eighteen OPN, 11 LPN and 41 RPN cases were identified and reviewed. All preoperative and perioperative parameters were similar, except for operative time, which was significantly shorter in the OPN group compared with those undergoing LPN and RPN (135 vs 189 and 225 min, respectively; p-value = 0.001). Of these 70 patients, 59 were deemed eligible for and included in trifecta analysis, which revealed similar trifecta outcomes (64.29%, 45.45%, and 64.71% in the OPN, LPN, and RPN groups, respectively; p-value = 0.388). Univariate analysis showed that length of hospital stay was a negative associated factor for trifecta achievement (p-value = 0.007, 95% CI = 0.619 (0.44–0.88)). Conclusion Although OPN displayed the shortest operative time, the trifecta achievement rate was not significantly different among the three groups. The sole parameter, which was negatively associated with trifecta outcome achievement, was the length of hospital stay.

Purpose: To compare the trifecta outcome and perioperative and postoperative outcomes among open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted partial nephrectomy (RAPN) in patients with small renal masses in Ramathibodi Hospital.Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy from January 2009 to December 2018. The baseline characteristics and preoperative outcomes were compared among the three surgical approaches. Results: Among the 141 patients, 42 (29.79%), 29 (20.57%), and 70 (49.64%) patients underwent OPN, LPN, and RAPN, respectively. Among 116 patients with available data, 71 achieved the trifecta outcome [18 (56.25%), 14 (56.00%), and 39 (73.58%) in the OPN, LPN, and RAPN group, respectively; p=0.276]. The rate of conversion to OPN was higher in the LPN than RAPN group. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. The estimated blood loss was significantly lower in the LPN group than OPN and RAPN groups (p=0.041). The operative time was shorter in the OPN group than LPN and RAPN groups (p<0.001). Multivariate analysis showed that the intraoperative complication rate was a predictive factor for trifecta outcome achievement.Conclusion: OPN had the shortest operative time. LPN had the highest rate of conversion to OPN and lowest estimated blood loss. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. However, achievement of the trifecta outcome was not significantly different among the three groups. The predictive factor for trifecta outcome achievement was the intraoperative complication rate.