Login to Access Video or Poster Abstract: MP59-06
Sources of Funding: none

Introduction

During robot-assisted partial nephrectomy (RAPN), surgeons often face difficulty exposing the renal hilum and tumor before tumor resection and renorrhaphy. Consequently, operative time may be prolonged. In the present study, we aimed to identify the predictive factors associated with prolonged operative time for RAPN.

Methods

Patients who underwent transperitoneal RAPN for renal tumor at our institution between 2012 and 2015 were retrospectively analyzed. Early cases managed after the adoption of the da Vinci surgical system were excluded. Multivariate regression analysis was used to test associations between prolonged operative time (>150 min) and perioperative factors.

Results

In total, 297 patients were included in this study; however, 95 early cases were excluded. RAPN was performed by 3 experienced surgeons using an early unclamping technique. The median operative time was 132 min (interquartile range, 109–155 min) and operative time was prolonged in 62 cases. The cohort of patients with prolonged operative time (prolonged group) was significantly older (P=0.0018), had a higher male–female ratio (P=0.02), and had higher BMI (P=0.0093) than the group with shorter operative times (standard group). In addition, the tumor was also more likely to be larger (P=0.025), on the left side (P=0.005), and posteriorly positioned (P=0.03). Furthermore, the RENAL nephrometry score was likely to be higher for the prolonged group compared with the standard group. Moreover, warm ischemia time was longer (21 vs. 16 min; P<0.0001) and postoperative decrease in renal function (3 months) was greater (–9.0 vs. –4.7%; P=0.038) for the prolonged group than for the standard group. Multivariate analysis indicated that age (odds ratio [OR], 1.04; P=0.0015), BMI (OR, 1.12; P=0.013), left-sidedness (OR, 3.21; P=0.0007), posterior position (OR, 2.47; P=0.016), and high RENAL score (OR, 3.39; P=0.012) were significantly associated with prolonged operative time.

Conclusions

In addition to tumor complexity, age, BMI, and left-sidedness are predictive of prolonged operative times for RAPN. These factors may contribute to the difficulty exposing the renal hilum and renal tumor. Further investigation of the time spent during each part of the procedure is indicated.

Funding

none