Prospective evaluation of the effect of adherent perinephric fat on outcomes of robotic assisted partial nephrectomy following elimination of the learning curve

Abstract

Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.

Perinephric Toxic Fat: Impact on Surgical Complexity, Perioperative Outcome, and Surgical Approach in Partial Nephrectomy

“…We did not observe a significant difference in warm ischemia time in both subgroups, and there was no difference in positive surgical margins or in overall complications. This is in line with Shumate et al’s [26] recently published results of 205 patients undergoing RAPN. In that study, the presence of APF was not associated with warm ischemia time, positive surgical margins, or any postoperative complications [26].…”

“…This is in line with Shumate et al’s [26] recently published results of 205 patients undergoing RAPN. In that study, the presence of APF was not associated with warm ischemia time, positive surgical margins, or any postoperative complications [26]. Although Khene et al [9] did not find high MAP scores to be an independent risk factor for the development of major postoperative complications, they found the MAP score as continuous variable to be adversely associated with TRFECTA achievement.…”

Validation of the Mayo Adhesive Probability score as a predictor of adherent perinephric fat and outcomes in open partial nephrectomy

“…Shumate et al, studied the association of APF in perioperative outcomes of 100 patients undergoing RAPN following elimination of the surgical learning curve. This group found that even after elimination of the learning curve, APF was associated with an increased operative time (19). Further studies should be conducted in order to identify additional factors that aid in the prediction of the presence of intraoperative APF in patients undergoing partial nephrectomy (20).…”

Senhance robot-assisted adrenalectomy: a case series

“…Our patient did not need blood transfusion, and this event did not considerably affect the length of hospital stay since the discharge was on the fifth postoperative day. We had one conversion to laparoscopy due to APF, which is a described limiting factor in robot-assisted renal surgery ( 9 ). Conversions are common, with 1%-10% conversions to laparoscopic adrenalectomy and 1% to open adrenalectomy ( 1 ).…”