The surgical difficulty of partial nephrectomy (PN) varies depending on the operative approach. Existing nephrometry classifications for assessment of surgical difficulty are not specific to the robotic approach.
To develop an international robotic-specific classification of renal masses for preoperative assessment of surgical difficulty of robotic PN.
The RPN classification (Radius, Position of tumour, iNvasion of renal sinus) considers three parameters: tumour size, tumour position, and invasion of the renal sinus. In an international survey, 45 experienced robotic surgeons independently reviewed de-identified computed tomography images of 144 patients with renal tumours to assess surgical difficulty of robot-assisted PN using a 10-point Likert scale. A separate data set of 248 patients was used for external validation.
Multiple linear regression was conducted and a risk score was developed after rounding the regression coefficients. The RPN classification was correlated with the surgical difficulty score derived from the international survey. External validation was performed using a retrospective cohort of 248 patients. RPN classification was also compared with the RENAL (Radius; Exophytic/endophytic; Nearness; Anterior/posterior; Location), PADUA (Preoperative Aspects and Dimensions Used for Anatomic), and SPARE (Simplified PADUA REnal) scoring systems.
The median tumour size was 38 mm (interquartile range 27-49). The majority (81%) of renal tumours were peripheral, followed by hilar (12%) and central (7.6%) locations. Noninvasive and semi-invasive tumours accounted for 37% each, and 26% of the tumours were invasive. The mean surgical difficulty score was 5.2 (standard deviation 1.9). Linear regression analysis indicated that the RPN classification correlated very well with the surgical difficulty score (R2 = 0.80). The R2 values for the other scoring systems were: 0.66 for RENAL, 0.75 for PADUA, and 0.70 for SPARE. In an external validation cohort, the performance of all four classification systems in predicting perioperative outcomes was similar, with low R2 values.
The proposed RPN classification is the first nephrometry system to assess the surgical difficulty of renal masses for which robot-assisted PN is planned, and is a useful tool to assist in surgical planning, training and data reporting.
We describe a simple classification system to help urologists in preoperative assessment of the difficulty of robotic surgery for partial kidney removal for kidney tumours.
European urology open science. 2023 Jun 15*** epublish ***
Dinesh K Agarwal, Clancy Mulholland, Digsu N Koye, Niranjan Sathianathen, Henry Yao, Philip Dundee, Daniel Moon, Marc Furrer, Christina Giudice, Wayland Wang, Julie A Simpson, Jamie Kearsley, Briony Norris, Homi Zargar, Henry Y C Pan, Ashwin Agarwal, Nathan Lawrentschuk, Niall M Corcoran, International Collaborative Group of Urologists
Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia., Centre for Epidemiology and Biostatics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia., Department of Urology, Western Health, Melbourne, Australia., University of Melbourne, Royal Melbourne Clinical School, Melbourne, Australia., Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia., St. Vincent's Clinical School, University of Melbourne, Melbourne, Australia.