Achieving the “trifecta” with open versus minimally invasive partial nephrectomy

Ghavimi, Samrad; Saarela, Olli; Pouliot, Frédéric; Rendon, Ricardo; Finelli, Antonio; Kapoor, Anil; Moore, Ronald B.; Breau, Rodney H.; Lavallée, Luke T.; Lacombe, Louis; Fairey, Adrian; Jewett, Michael A.S.; Liu, Zhihui; Tanguay, Simon; Black, Peter C.

doi:10.1007/s00345-020-03349-y

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…During the overview of the available literature, it was possible to derive two dominant definitions regarding trifecta. According to the first definition, the absence of positive surgical margins and complications and the absolute percentage decrement in the estimated glomerular filtration rate (|ΔeGFR|) by less than or equal to 10% were incorporated in the trinity of the trifecta concept (3,(16)(17)(18). On the other hand, according to the second definition, the trinity of the trifecta outcome included the absence of positive surgical margins and complications as well as duration of ischemia time (IT) less than 25 min (2,(19)(20)(21)(22)(23).…”

Section: Methodsmentioning

confidence: 99%

“…researchers describe the statistically significant superiority of RAPN over OPN regarding the outcome of positive surgical margins rates (3.6% vs. 11.5%, p=0.01). On the contrary, the second study was conducted by Ghavimi and colleagues in 2020 (17), with the authors considering the "trifecta outcome" as an overall measure of effectiveness of the surgical treatment provided in patients with clinical stage T1 (cT1) renal masses through nephron-sparing surgery (NSS). Specifically, groups of patients who underwent open, laparoscopic, and robotic partial nephrectomy were compared, while their baseline characteristics were comparable.…”

Section: Studymentioning

confidence: 99%

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Considering “Trifecta” as a Single Outcome when Comparing Robotic With Open Partial Nephrectomy: A Mathematical Model of Volume Conservation and Systematic Review

Artsitas

Segkou

et al. 2022

In Vivo

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Background/Aim: Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the criteria required for its fulfilment. The present study aimed to highlight the potential of a unified view for the different definitions of trifecta when comparing robotic and open approaches in partial nephrectomy. Materials and Methods: A systematic literature search was carried out for all relevant comparative studies published until April 2022. Trifecta definitions were clustered according to two criteria for postoperative renal function reduction. The first set as an upper limit the 10% decrease in the estimated glomerular filtration rate, while the second set as an upper limit 25 min of ischemia. To mathematically investigate the point of intersection between the above two groups, a suitable model of volume conservation equations was formulated. Results: A total of 11 studies were investigated for their methodological features and grouped accordingly. The ischemic zone volume surrounding the tumor resection site emerged as the central parameter connecting the two main definitions. Specifically, for patients with solitary renal masses, a given change in the value of one parameter resulted in a fixed change in the value of the other. Conclusion: The two main definitions of the "trifecta outcome" extracted from the international literature represent the two sides of the same coin. Thus, trifecta achievement rates could be utilized by future studies as aggregate data to yield a quantitative estimate of the comparative effect between robotic and open approaches in partial nephrectomy procedures.

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Section: Methodsmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

Considering “Trifecta” as a Single Outcome when Comparing Robotic With Open Partial Nephrectomy: A Mathematical Model of Volume Conservation and Systematic Review

Artsitas

Segkou

et al. 2022

In Vivo

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“…In the past, clinicians often performed open partial nephrectomy (OPN). With the development of laparoscopic technology, laparoscopic partial nephrectomy (LPN) has replaced OPN as the standard treatment for localized renal tumors (3)(4)(5)(6)(7)(8). Although LPN has significantly improved the overall prognosis of patients with renal tumors, it could simultaneously increase the risk of postoperative chronic kidney disease, such as long-term postoperative hematuria, infection, and renal insufficiency (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of robotic-assisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors

et al. 2022

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ObjectiveThis study aimed to investigate the safety and efficacy of renal hypothermic perfusion by renal artery balloon catheter during robot-assisted laparoscopic partial nephrectomy (P-RALPN) for patients with complex renal tumors.Materials and methodsWe retrospectively identified 45 patients with complex renal tumors who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN) and 11 patients treated with P-RALPN from September 2017 to October 2021. Preoperative patients’ characteristics and intraoperative surgical parameters including operating time, blood loss, hospitalization, pre- and post-surgical glomerular filtration rate (GFR), and postoperative survival time were collected and compared between the two groups. The patients’ body temperature, real-time kidney temperature, and short-term renal function were analyzed in the P-RALPN group.ResultsThere was no statistically significant difference on median intraoperative estimated blood loss and postoperative hospitalization between the two groups. Patients who received P-RALPN had a slightly longer operative time than those who received S-RALPN (103.1 versus 125.9; p = 0.09). In the P-RALPN group, the volume of perfusion solution was 533.2 ml (range, 255.0–750.0 ml), the median temperature of kidney was 22.6°C (range, 21.7–24.1°C) after the kidney cools down, and the median minimum intraoperative temperature of patients was 36.1°C (range 35.2–36.7°C). The ischemia time in the S-RALPN group was markedly lower than that in the P-RALPN group (21.5 versus 34.8; p < 0.01). However, the loss of GFR was much higher for the S-RALPN group after the surgery. (28.9 versus 18.4; p < 0.01). Importantly, patients had similar postoperative survival time between the two groups (p = 0.42; HR = 0.27).ConclusionP-RALPN is a safe and feasible surgery in the treatment of patients with complex renal tumors, which provides a new operative approach for clinicians to treat these patients.

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Comparing robotic and open partial nephrectomy under the prism of surgical precision: a meta-analysis of the average blood loss rate as a novel variable

Artsitas,

Koronaki

et al. 2024

J Robotic Surg

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Exploration of surgical precision in robotic procedures is extensive, yet lacks a unified framework for comparability. This study examines tissue handling precision by comparing the per-minute blood loss rate between robotic and open partial nephrectomy. A literature search from August 2022 to June 2024 identified 43 relevant studies providing data on estimated blood loss and procedure duration. The expected values and standard errors of these variables were used to compute the per-minute blood loss rate (Q). Meta-analytical methods estimated pooled and subgroup-level mean differences, favoring robotic surgery (MDQ = − 1.043 ml/min, CI95% = [− 1.338; − 0.747]). Subgroup analyses by publication year, patient matching, referral center count, and ROBINS-I status consistently supported this advantage. Sensitivity analyses confirmed the above benefit in studies with increased accuracy in reported results (MDQ = – 0.957 ml/min, CI95% = [– 1.269; – 0.646]), low risk of bias involving matched comparisons (MDQ = – 0.563 ml/min, CI95% = [– 0.716; – 0.410]), large sample sizes and increased statistical power (MDQ = – 0.780 ml/min, CI95% = [– 1.134; – 0.425]), and multicenter analyses with patient matching (MDQ = – 0.481 ml/min, CI95% = [– 0.698; – 0.263]). The subsequent analysis of correlation between the original variables suggested a slight reduction in the robotic advantage when the latter were proportionally related. Multilevel meta-regression at both temporal and qualitative scales consistently indicated a comparative benefit of the robotic approach. Potentially, lower per-minute blood loss compared to open surgery suggests that robotic partial nephrectomy demonstrates enhanced precision in tissue handling.

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Achieving the “trifecta” with open versus minimally invasive partial nephrectomy

Cited by 5 publications

References 25 publications

Considering “Trifecta” as a Single Outcome when Comparing Robotic With Open Partial Nephrectomy: A Mathematical Model of Volume Conservation and Systematic Review

Considering “Trifecta” as a Single Outcome when Comparing Robotic With Open Partial Nephrectomy: A Mathematical Model of Volume Conservation and Systematic Review

Clinical outcomes of robotic-assisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors

Comparing robotic and open partial nephrectomy under the prism of surgical precision: a meta-analysis of the average blood loss rate as a novel variable

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