NARUS 2018: Medial Versus Lateral Camera Port Placement for Robotic Nephron-Sparing Surgery: Evaluating Surgical Complications and Outcomes
Methods
During 2013-2016, all robotic surgery for renal lesions were examined. A total of 229 cases were analyzed. Patient demographics and comorbidities were analyzed along with perioperative surgical data including location of camera port, surgery length, warm ischemia time, blood loss, pathological tumor margins, tumor size, length of stay and laboratory data.
Outcomes
134 patients had surgery performed with lateral camera port placement versus 95 medial. Operative time was significantly better in the lateral camera port placement with average operative time of 165.8 minutes versus 209.1 medial (p <0. 0001) and warm ischemia time was less in the lateral group with an average of 11 minutes versus 15. 5 minutes medially (p <0. 0001) Blood loss was less in the lateral camera port group with an average of 158.2mL (+/- 196.5mL) versus 248.6mL (+/- 252.6) (p=0.0040). Drain use, positive surgical margin rate, transfusion rate, conversion to radical nephrectomy, change in preoperative versus postoperative creatinine and glomerular filtration rate, and length of hospital stay did not statistically differ.
Conclusion
The authors concluded that lateral camera port placement is associated with decreased operative time and warm ischemia time. There may be certain laparoscopic advantages to obtain a better visualization of surgical anatomy, thus allowing for faster extirpation of renal lesions and decrease in surgical time. These advantages may result in better long-term renal function and decreased clinical sequela from chronic kidney disease.
Presented by: Jamie Olsen, Charleston, USA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV