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J Robot Surg. 2019 Jun;13(3):423-428. doi: 10.1007/s11701-018-0883-5. Epub 2018 Oct 12.

A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney.

Author information

1
Department of Urology, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 6th Floor, 10029, New York City, NY, USA.
2
OhioHealth Dublin Methodist Hospital, 7500 Hospital Dr., Dublin, OH, 43016, USA.
3
Temple University School of Medicine, 255 South 17th Street, 7th floor, Philadelphia, PA, 19103, USA.
4
Division of Urology, Mount Sinai Medical Center, Columbia University at Mount Sinai, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA.
5
Wake Forest School of Medicine, Medical Center Blvd., Wake Forest University Baptist Medical Center, Winston-Salem, NC, 27157, USA.
6
Swedish Urology Group, Swedish Medical Center, 1101 Madison Suite 1400, Seattle, WA, 98104, USA.
7
Department of Urology, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 6th Floor, 10029, New York City, NY, USA. ketan.badani@mountsinai.org.

Abstract

To evaluate peri- and post-operative outcomes after robotic partial nephrectomy (RPN) in patients with a solitary kidney. A multi-institutional database of 1868 patients was used to identify 35 patients with a solitary kidney who underwent RPN at six different centers from 2007 to 2016. Peri-operative outcomes were summarized with descriptive statistics. We assessed the change in eGFR over time with a linear mixed-effects model. Median operative time, ischemia time, and estimated blood loss were 172 min, 16 min, and 113 mL, respectively. There were no positive surgical margins. The median length of stay was 1 day (range 1-7), and over half (54.3%) of patients were discharged one post-operative day 1. Seven post-operative complications occurred in six patients (17.1%); of which four were Clavien I, two were Clavien II, and one was Clavien III. The linear decline in eGFR up to 24 month post-RPN was marginal and not significant (ß = - 0.14; 95% CI = - 0.51, 0.23; p = 0.453), with predicted mean eGFR decreasing from 59.2 to 55.8 mL/min/1.73 m2 at 24 months. These results suggest that, in patients with a solitary kidney, RPN is a safe and feasible treatment option. In patients with a solitary kidney, RPN did not significantly compromise renal function for up to 2 years after surgery.

KEYWORDS:

Glomerular filtration rate; Nephron sparing surgery; Partial nephrectomy; Renal cancer; Robotics; Solitary kidney

PMID:
30315391
DOI:
10.1007/s11701-018-0883-5

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