Endoscopic robot‐assisted simple enucleation of renal tumours: Impact of learning curve and tumour complexity on trifecta outcomes

Abstract

Background In this article, we report the outcomes of endoscopic robot‐assisted tumour enucleation (ERASE) using a trifecta system. Methods One hundred eighty‐two patients were treated with ERASE by a single surgeon between October 2014 and February 2017 and were stratified by quartiles of distribution called ERASE eras 1 to 4 and preoperative aspects and dimensions used for an anatomical (PADUA) score risk group categories. The trifecta achievement rates in different ERASE eras and PADUA score risk group categories were analysed. Results The overall trifecta achievement rate was 76.4%; this rate progressively increased along the learning curve and reached 87.2% in ERASE era 4 (0.002). PADUA score risk group categories were inversely correlated with the trifecta achievement rate (P < .001). When both variables were simultaneously considered, a trend towards a higher trifecta achievement rate was observed in the recent series regardless of tumour anatomical complexity. Conclusions The trifecta achievement rate increased with surgical experience and was inversely correlated with tumour complexity.

Greater Renal Function Benefit from Enucleation Technique for More Complex Renal Tumors in Robot-Assisted Partial Nephrectomy

“…This is partly in line with a previous report by Lu and colleagues, which showed inverse relationship between preoperative aspects and dimensions used for an anatomical score and trifecta achievement rate. 23 We previously reported that larger tumor contact surface area is associated with more parenchymal volume loss in RAPN. 15 As more vascularized renal parenchyma is likely to be included in tumors with high RNS (large diameter, hilar, and median polar location), a running suture for kidney reconstruction owes unavoidable risk of compromising intrarenal vascular anatomy.…”