Achieving Trifecta outcomes early in the robotic assisted partial nephrectomy learning curve
Dhanika Samaranayake Dr1,2, Trent Pattenden Dr1, Greg Malone Dr1,2, Isaac Thangasamy Dr1.
1Urology, Ipswich Hospital, Ipswich, Queensland, Australia; 2Urology, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
Introduction: Achieving Trifecta outcomes in robotic assisted partial nephrectomy (RAPN) is desirable for improved patient safety and clinical outcomes. This study aimed to evaluate achievement of Trifecta outcomes for RAPN during the initial learning curve period for an experienced laparoscopic surgeon.
Method: Forty-nine consecutive RAPN cases performed at a tertiary centre in Queensland, Australia were reviewed retrospectively. The demographic, histolopathology and perioperative data was collected including length of surgery, intraoperative blood loss and warm ischaemic time (WIT). The Trifecta was defined as negative surgical margin, zero perioperative complications and warm ischemia time (WIT) of less than 20 mins.
Results: The mean operative time was 139 (57- 235) minutes, and the mean estimated blood loss was 190 (20 - 600) mls. Intraoperative hilar clamping was not performed in 5 cases. The mean WIT was 16 (8 - 28) mins. The mean lesion diameter was 28 (6 - 52) mm. The overall complication rate was 12.2%, of which >80% were Clavien-Dindo grade II or less. Positive surgical margins were found in 4.1% of cases. The mean length of hospital was 4.2 (2 - 9) days. Trifecta outcome were achieved in 71.4% cases. There was no significant difference in incidence of Trifecta outcomes between the first 25 cases (72%) and the last 24 cases (71%).
Conclusion: The Trifecta outcomes of negative surgical margins, no perioperative complications and a WIT of less than 20mins may be achieved early in a surgeons learning curve with robotic assisted surgery. To achieve excellent surgical and histological outcomes a good surgical team and reproducible surgical technique is essential.
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