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Beauval JB, Khene ZE, Roumiguié M, Rahota R, Mejean A, Doumerc N, Roupret M, Paparel P, Villers A, Bruyere F, Lebacle C, Nouhaud FX, Champy C, de la Taille A, Lang H, Rizk J, Durand M, Dariane C, Charles T, Boissier R, Long JA, Bigot P, Bensalah K, Bernhard JC. Open versus robotic partial nephrectomy in obese patients: a multi-institutional propensity score-matched analysis (UroCCR 43-Robese study). World J Urol 2024; 42:213. [PMID: 38581466 DOI: 10.1007/s00345-024-04890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/06/2023] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION There is limited evidence on the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) in obese patients (BMI ≥ 30 kg/m2). In this study, we aimed to compare perioperative and oncological outcomes of RPN and OPN. METHODS We relied on data from patients who underwent PN from 2009 to 2017 at 16 departments of urology participating in the UroCCR network, which were collected prospectively. In an effort to adjust for potential confounders, a propensity-score matching was performed. Perioperative outcomes were compared between OPN and RPN patients. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Overall, 1277 obese patients (932 robotic and 345 open were included. After propensity score matching, 166 OPN and 166 RPN individuals were considered for the study purposes; no statistically significant difference among baseline demographic or tumor-specific characteristics was present. A higher overall complication rate and major complications rate were recorded in the OPN group (37 vs. 25%, p = 0.01 and 21 vs. 10%, p = 0.007; respectively). The length of stay was also significantly longer in the OPN group, before and after propensity-score matching (p < 0.001). There were no significant differences in Warm ischemia time (p = 0.66), absolute change in eGFR (p = 0.45) and positive surgical margins (p = 0.12). At a median postoperative follow-up period of 24 (8-40) months, DFS and OS were similar in the two groups (all p > 0.05). CONCLUSIONS In this study, RPN was associated with better perioperative outcomes (improvement of major complications rate and LOS) than OPN. The oncological outcomes were found to be similar between the two approaches.
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Affiliation(s)
- Jean Baptiste Beauval
- Department of Urology, Clinique La Croix du Sud, Quint Fonsegrives, Toulouse, France.
| | | | - Mathieu Roumiguié
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | - Razvan Rahota
- Department of Urology, Clinique La Croix du Sud, Quint Fonsegrives, Toulouse, France
| | | | - Nicolas Doumerc
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | - Morgan Roupret
- Department of Urology, La Pitié Salpétrière, Paris, France
| | | | | | - Franck Bruyere
- Department of Urology, University Hospital, Tours, France
| | - Cédric Lebacle
- Department of Urology, Kremlin Bicetre University Hospital, Paris, France
- Department of Urology, University Hospital, Bordeaux, France
| | | | - Cécile Champy
- Department of Urology, Mondor University Hospital, Créteil, France
| | | | - Hervé Lang
- Department of Urology, University Hospital, Strasbourg, France
| | - Jérome Rizk
- Department of Urology, St Joseph Hospital, Paris, France
| | - Mathieu Durand
- Department of Urology, University Hospital, Nice, France
| | | | - Thomas Charles
- Department of Urology, University Hospital, Poitiers, France
| | - Romain Boissier
- Department of Urology, University Hospital, Marseille, France
| | | | - Pierre Bigot
- Department of Urology, University Hospital, Angers, France
| | - Karim Bensalah
- Department of Urology, University Hospital, Rennes, France
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Harris AM, Lewis IR, Averch TD. Patient Safety and Quality Improvement in Minimally Invasive Surgery. J Endourol 2024; 38:170-178. [PMID: 37950717 DOI: 10.1089/end.2022.0733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Background: The journey of minimally invasive (MI) urology is one of quality improvement (QI) and patient safety. New techniques have been progressively studied for adoption and growth. As more advanced methods of data collection and analysis are developed, a review of the patterns and history of these principles in the development of MI urology can inform future urologic QI and patient safety initiatives. Objective: To perform a scoping review identifying patterns of QI and patient safety in MI urology. Methods: PubMed and the American Urological Association (AUA) journal search page were screened on December 2022 for publications using the search parameters "quality improvement" and "minimally invasive." Articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). Results: The initial literature search identified 471 articles from PubMed and 57 from the AUA journal search page. After screening, 528 articles were relevant to the topic and reviewed. Four hundred eighty-two articles were duplicates or did not meet inclusion criteria. Forty-six are included in this review. Conclusion: Urology has developed a pattern of assessing MI surgery vs the open counterpart. This includes analyzing the newest approach to understand complications, examining the factors contributing to complications, and lastly designing projects to mitigate future risk. This information, as well as advanced methods of data collection, has identified areas of improvement for new QI projects. The stage is set for a promising future with the adoption of advanced QI in daily urologic practice to improve patient safety and minimize errors.
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Affiliation(s)
- Andrew M Harris
- Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Isabelle R Lewis
- Division of Urology, Department of Surgery, Prisma Health Midlands-University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Timothy D Averch
- Division of Urology, Department of Surgery, Prisma Health Midlands-University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Adem RY, Hassen SM, Abdulaziz M, Ahmed AI, Jemberie AM, Gebeyehu YT, Sedeta AM, Gebrehiwot FG, Abebe E, Berhe T. Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country. Res Rep Urol 2022; 14:389-397. [DOI: 10.2147/rru.s376720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
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