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ORIGINAL ARTICLE Free access
Minerva Urologica e Nefrologica 2019 April;71(2):127-35
DOI: 10.23736/S0393-2249.18.03276-9
Copyright © 2018 EDIZIONI MINERVA MEDICA
language: English
Cold ischemia technique during robotic partial nephrectomy: a propensity score-matched comparison with open approach
Juan GARISTO 1, Riccardo BERTOLO 1, Jose AGUDELO 1, Sherif ARMANYOUS 2, Tianming GAO 3, Michael LIOUDIS 2, Jihad H. KAOUK 1 ✉
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; 2 Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; 3 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
BACKGROUND: Open ice slush for renal cooling during partial nephrectomy (PN) has been reproduced during robotic PN (RPN). The aim of this study was to compare the perioperative and functional outcomes between RPN and open PN (OPN) using a cold ischemia technique.
METHODS: Consecutive patients undergoing PN using cold ischemia technique were extracted from our prospectively-maintained database (2007-2016). RPN and OPN patients were 1:2 propensity-score (PS) matched via a greedy algorithm. The balance of the baseline variables was checked for the matched cohorts. Perioperative and functional outcomes were compared.
RESULTS: Fifty-one RPN and 334 OPN using cold ischemia were extracted. After PS adjustments, 51 RPN vs. 102 OPN with no significant differences in baseline features were compared. Regarding perioperative outcomes, blood loss (100 mL [IQR 50; 200] vs. 260 mL [IQR 200; 350], <0.001), postoperative complications rate (10 patients (19.6%) vs. 38 patients (37.3%), P=0.027) and hospital stay (3 days [IQR 2; 4] vs. 5 days [IQR 4; 6], P<0.001) favored RPN. Renal functional outcomes were comparable at repeated measures analysis.
CONCLUSIONS: In our experience, cold ischemia technique can be effectively reproduced during RPN, with a potential advantage in terms of blood loss, complications rate and hospital stay over the traditional OPN procedure.
KEY WORDS: Cold ischemia; Nephrectomy; Kidney neoplasm; Robotics