WCE 2017: 5 Year Perioperative Outcomes of Robot-Assisted Laparoscopic Partial Nephrectomy

Vancouver, Canada (UroToday.com) Dr. Andrew Rasmussen, Urology resident of the University of Alberta, presented data on the 90-day perioperative outcomes of patients undergoing robot-assisted laparoscopic partial nephrectomy (RPN) at the University of Alberta. RPN is still a relatively new surgery due to the novelty of robots and the inexperience surgeons had with these robots. As surgeons around the world gain experience and confiedence, RPNs are becoming increasingly common. However, as RPNs are just now gaining traction, there is only sparse data supporting robotic outcomes. Dr. Rasmussen and his team therefore created a study to review the 90-day intra- and perioperative outcomes of patients undergoing RPNs between 2011 and 2016 at the University of Alberta.

The research team primarily focused on finding the 90-day complication rate of RPNs, but had many secondary objectives such as discovering the intra-operative blood loss, 90-day transfusion rate, post-operative hemoglobin change, margin status, artery clamp type, length of stay, and any differences between patient demographics. Therefore, they completed a retrospective review of patient charts.

274 patients were identified who had a RPN procedure by 1 of 3 surgeons with more than 60% of procedures performed by a single surgeon. After analyzing the data, Dr. Rasmussan's team found the 90-day complication rate to be 11.2%. Of this, 60% were high grade complications. The 90-day transfusion rate was 7.8%, the positive surgical margin was 6.5%, and the percent of patients with a misdiagnosed tumor (benign instead of metastatic) was 14.6%.

Dr. Rasmussen acknowledged his hospital had a lot to work on regarding the positive surgical margin rate and 90-day transfusion rate as they were noticeably higher than the average in the country. He noticed how the most common complication was bleeding that required embolization which he visibly did not like. He also believed that the true complication rate was higher than suggested in the study as it was retrospective. From this, Dr. Rasmussen wants to finalize their database, use this data to contribute to CKCIS, and keep prospectively collecting data. One audience member asked what Dr. Rasmussen thinks is the reason the transfusion rate was higher than average to which the Dr. replied he was not sure but one possible reason could be the 2 other surgeons were relatively new and so their inexperience could have caused the higher transfusion rate.

Authors: A Rasmussen, H Evans, B St.Martin, M Hobart, T Schuler
Affiliation: University of Alberta

Speaker: Andrew Rasmussen

Written By: Vinay Cooper, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada