Background:Randomized controlled trial has shown that dexmedetomidine does not significantly reduce postoperative acute kidney injury (AKI) in general partial nephrectomy (PN) populations. However, evidence remains limited in patients with high susceptibility to renal ischemia, such as those with a solitary kidney or pre-existing chronic kidney disease (CKD). Methods:We conducted a single-center retrospective cohort study including adult high-risk PN patients between 2015 and 2023. Eligible high-risk patients were those with a solitary kidney or pre-existing CKD. The study cohort was divided into dexmedetomidine-exposed and non-exposed groups. To balance baseline characteristics, inverse probability of treatment weighting (IPTW) was applied. The primary outcome was AKI incidence within 24 hours postoperatively, defined by KDIGO creatinine criteria. Results:The study included 274 patients, with 82 assigned to the dexmedetomidine-exposed cohort and 192 to the non-exposed cohort. After IPTW adjustment, all baseline covariates were well balanced. Dexmedetomidine exposure was associated with significantly lower AKI incidence (23.9% versus 38.6%, P = 0.025), with a trend toward milder AKI staging. Intraoperative urine output was higher in the dexmedetomidine group (341 ± 183 versus 282 ± 188 mL, P = 0.022). Length of postoperative hospital stay, postoperative complications, ICU admission rate, percentage decrease in eGFR from baseline at 6-month follow-up, and incidence of a >20% decrease from baseline eGFR at 6-month follow-up did not differ significantly between the two groups. Conclusion:In high-risk PN patients with a solitary kidney or pre-existing CKD, intraoperative dexmedetomidine was associated with a clinically meaningful reduction in postoperative AKI. These findings suggest a potential renoprotective role of dexmedetomidine in this vulnerable surgical population, although this early renal benefit did not translate into long-term improvements in renal function.

BACKGROUND:This study aimed to evaluate the feasibility, safety and effectiveness of the newly developed KangDuo-Surgical-Robot-2000 (KD-SR-2000) in robotic assisted radical prostatectomy (RARP). METHODS:This prospective, multicenter, single-arm trial was conducted from October 2023 to April 2024. Thirty patients with clinical T1-3 prostate cancer underwent RARP using the KD-SR-2000. The study was approved by the institutional review boards. Perioperative results, early oncologic outcomes, urinary continence, and ergonomic workload (NASA-TLX) were assessed. RESULTS:All surgeries were performed successfully without any conversion. No severe perioperative complications (Clavien-Dindo grade ≥ III) or equipment-related adverse events occurred. Positive surgical margin was observed in five patients (16.7%). One (3.3%) patient experienced PSA persistence at 6 weeks. Urinary continence rate was 66.7% (20/30) at 4 weeks after catheter removal. The median NASA-TLX score was 22.5 (IQR 6-35.25). CONCLUSIONS:This study demonstrates the preliminary feasibility, safety and effectiveness of the KD-SR-2000 robotic system in RARP. TRIAL REGISTRATION:www.chictr.org.cn: ChiCTR2300076954.

BACKGROUND AND OBJECTIVE:Accurately distinguishing between cancerous and noncancerous tissues during robot-assisted radical prostatectomy (RARP) is a challenge that can increase the risk of residual disease. This study aimed to evaluate the safety, optimal dose and accuracy of a dual-modality prostate-specific membrane antigen (PSMA)-targeted probe (68Ga-P3) for preoperative positron emission tomography (PET)/computed tomography (CT) imaging and intraoperative fluorescence imaging in prostate cancer. METHODS AND SURGICAL PROCEDURE:Each participant received an intravenous chemical dose of 68Ga-P3 (10, 20, and 40 μg/kg), with radioactivity of 3.7 MBq/kg. PET/CT imaging was conducted 30, 60, and 120 min after injection to evaluate its biodistribution and dosimetry. RARP was performed at 24 ± 6 h after injection, in the sensitive mode of Firefly fluorescence imaging. KEY FINDINGS AND LIMITATIONS:Between May 2024 and July 2024, a total of 16 patients were included; 68Ga-P3 was well tolerated without any adverse events related to 68Ga-P3 administration or fluorescence imaging. At 2 h after administration, the median tumor maximum standardized uptake value was 5.3 (4.1-8.1). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 68Ga-P3 PET/CT for tumor localization were 79.1%, 90.4%, 81.5%, and 89.0%, respectively. The overall NPV, PPV, and accuracy of intraoperative fluorescence imaging were 100%, 43.8%, and 90.9%, respectively. Of overall false-positive sites, 88.9% (8/9) were confirmed as tumor adjacent to the surgical margin. A dose of 40 μg/kg resulted in the highest accuracy of 92.3%. CONCLUSIONS AND CLINICAL IMPLICATIONS:In PSMA-targeted PET imaging and fluorescence-guided surgery, 68Ga-P3 is safe and feasible for use, offering a novel tool for the surgical management of prostate cancer.

BACKGROUND:Acute kidney injury (AKI) is a frequent complication after partial nephrectomy. Dexmedetomidine appears to protect against kidney injury in both in vitro and in vivo. We tested the primary hypothesis that perioperative administration of dexmedetomidine would reduce the incidence of postoperative AKI after partial nephrectomy. METHODS:This randomised, double-blind, placebo-controlled trial was conducted in a tertiary care hospital in Beijing, China with 290 participants randomly assigned to receive dexmedetomidine or saline at a loading dose of 0.6 μg kg-1 followed by continuous infusion at 0.4 μg kg-1 h-1 intraoperatively. Dexmedetomidine (200 μg) was also used as an adjuvant for patient-controlled i.v. analgesia with sufentanil after surgery. The primary outcome was the incidence of AKI, defined according to the creatinine criteria of the KDIGO (Kidney Disease: Improving Global Outcomes) criteria for AKI. RESULTS:Two surgeries were cancelled after randomisation, leaving 288 participants (mean age [range]: 55 [20-79] yr; 32% female) for the modified intention-to-treat analysis. AKI occurred in 32/144 (22%) participants randomly assigned to dexmedetomidine, compared with 33/144 (23%) participants randomly assigned to saline (risk ratio 0.97; 95% confidence interval 0.63-1.49; P=0.888). Secondary outcomes, including postoperative serum cystatin C and serum creatinine levels and estimated glomerular filtration rate in postoperative 6 months, were not different between groups. The incidence of safety outcomes was similar in each group. CONCLUSIONS:Perioperative dexmedetomidine administration did not reduce postoperative AKI after partial nephrectomy. CLINICAL TRIAL REGISTRATION:ChiCTR2200059536.

To develop a three-dimensional (3D) image based extended tumor plane technique for robotic-assisted partial nephrectomy (RAPN). We prospectively enrolled patients with a local renal tumor for RAPN between March 2019 and Mar 2022. 3D virtual model was reconstructed based on the computed tomography urography. The tumor plane was extended equidistantly (10 mm) to form a virtual plane. According to the relationship between the extended plane and the collection system, patients are divided into those with no collecting system involvement, renal medulla involvement, and renal calyx involvement. The primary endpoint was trifecta achievement, which was defined as warm ischemic time ≤ 25 min, negative surgical margins, and no major perioperative complications. This study enrolled a total of 215 patients. The median preoperative aspects and dimensions used for an anatomical (PADUA) score was 9 (6–15). The average warm ischemic time was 21.64 ± 9.35 min. Postoperative complications occurred in 26 (12.1

Background: The KangDuo Surgical Robot (KD-SR) is a newly developed surgical robot. Objective: To compare the safety and efficacy of robot-assisted radical prostatectomy (RARP) using the KD-SR with those of the da Vinci Si Surgical System (DV-SS-Si). Design, setting, and participants: A prospective double-center noninferiority randomized controlled trial was conducted among 18-75-yr-old patients with suspected T1-2N0M0 prostate cancer (PCa) scheduled for RARP. Intervention: RARP with the KD-SR (KD-RARP) versus RARP with the DV-SS-Si (DV-RARP). Outcome measurements and statistical analysis The primary outcome was surgical success, defined as follows: surgery can be performed according to the established protocol, without switching to other surgical modalities, and without secondary surgery due to surgical complications after surgery. The secondary outcome was short-term functional and oncological outcomes. The noninferiority threshold was set at 10%. Results and limitations: Eighty patients were enrolled, while the full analysis set finally included 79 patients (40 with KD-RARP and 39 with DV-RARP). The success rate was 100% in both groups. We could not find differences in urinary continence rate at 1, 2, 3, and 4 wk after catheter removal between the groups (p > 0.05). The rate of Clavien-Dindo grade II adverse events was 20% in the KD-RARP group and 17.9% in the DV-RARP group (p = 0.82), and no grade >= III adverse events occurred. The median operation time was significantly longer in the KD-RARP group than in the DV-RARP group (177.5 vs 145 min, p = 0.012). The main limitations were the short follow-up period and that survival was not considered as the primary outcome. Conclusions: The KD-SR is a viable option for RARP, with acceptable short-term outcomes compared with the DV-SS-Si for T1-2 PCa. Patient summary: This is the first prospective randomized controlled trial to compare the KangDuo Surgical Robot (KD-SR) versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted radical prostatectomy, which determines that the KD-SR is noninferior to the DV-SS-Si regarding safety and efficacy for T1-T2 prostate cancer. (c) 2024 Published by Elsevier B.V. on behalf of European Association of Urology.

Objectives To explore the relationship between Fuhrman grade of renal cell carcinoma (RCC) and the DDD score. Methods We reviewed the records of 527 nonmetastatic RCC patients. Demographic, clinical, and pathologic characteristics were reviewed. Binary logistic regression was used to explore the independent risk factors for high‐grade RCC (HGRCC). Results Sex, BMI (Body Mass Index), RNS, and DDD score were significantly correlated with HGRCC. Based on these independent risk factors, we constructed two predictive models integrating the RNS and DDD scores with sex and BMI to predict tumor grade. The calibration curves of the predictive model showed good agreement between the observations and predictions. The concordance indexes (C‐indexes) of the predictive models were 0.768 (95% CI, 0.713–0.824), and 0.809 (95% CI, 0.759–0.859). Receiver operating characteristic (ROC) curves were performed to compare the predictive power of the nomograms, and the prediction model including the DDD score had better prognostic ability ( p = 0.01). Conclusions This study found that RNS, DDD score, BMI, and sex were independent predictors of HGRCC. We developed effective nomograms integrating the above risk factors to predict HGRCC. Of note, the nomogram including the DDD score achieves better prediction ability for HGRCC.

INTRODUCTION:We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). MATERIALS AND METHODS:This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. RESULTS:There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). CONCLUSIONS:The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required.

Purpose: To investigate the feasibility, safety, and efficacy of the KangDuo-Surgical Robot-01 (KD-SR-01) system for robot-assisted radical nephroureterectomy (RARNU). Materials and Methods: This prospective, single-center, single-arm clinical study of patients with upper tract urothelial carcinoma (UTUC) was conducted from August 2022 to July 2023 using the KD-SR-01 system. The perioperative and follow-up data were prospectively recorded. The National Aeronautics and Space Administration task load index was calculated to present ergonomics. The technique was described in detail. Results: A total of 13 patients underwent RARNU. None of the cases conversed to laparoscopic procedure or open procedure. The median docking time and console time were 524 seconds (range 139-963 seconds) and 102.2 minutes (range 55.3-249.3 minutes), respectively. The median estimated blood loss was 40 mL (range 10-100 mL). None of the patients required intraoperative blood transfusion. The median postoperative hospital stay was 4 days (range 2-7 days). Intraoperative or postoperative complications (Clavien-Dindo grade I) occurred in nine patients. The surgeon task load index global score achieved 1.05 ± 1.86. Three patients received the single-docking technique, demonstrating similar perioperative results compared with patients with redocking. The study is registered at www.chictr.org.cn (ChiCTR2200056672). Conclusions: The KD-SR-01 system was feasible, safe, and effective for RARNU.

Background: Clear cell renal cell carcinoma (ccRCC) is one of the most common urological tumors, and its incidence is increasing year by year. Tumor stroma ratio (TSR) can reflect the amount of stromal component around tumor cells, and can independently predict the prognosis of tumor. This study aims to evaluate the prognostic value of TSR in ccRCC patients. Methods: From January 2010 to December 2015, clinical and histopathological data of patients with ccRCC patients who underwent surgical operation were collected. Using TSR (50%) as the cut-off value, the patients were divided into low-TSR group (<50%) and high-TSR group (>= 50%). The clinicopathological characteristics and survival status of patients were compared between the two groups. Univariate and multivariate analyses were used to identify the prognostic factors for overall survival (OS), cancer-specific Results: The mean age of 569 patients was 56.84 +/- 12.76 years old. There were 401 males and 168 females. According to the TSR, patients were divided into low-TSR group (n=333, 58.5%) and high-TSR group (n=236, 41.5%). The median follow-up time was 67.0 months (interquartile range, 33.0-72.0 months). The 5-year OS, CSS and MFS were 91.2%, 94.6% and 91.0%, respectively. The 5-year OS, CSS and MFS were 84.2%,89.7% and 82.7% in the high-TSR group and 96.1%, 98.0% and 96.0% in the low-TSR group (P<0.05). Multivariate analysis showed that age >60 years [hazard ratio (HR) =2.455, 95% confidence interval (CI): 1.292-4.668, P=0.006), tumor grade (HR =6.580, 95% CI: 3.276-13.216, P<0.001) and TSR (HR =2.611, 95% CI: 1.265-5.387, P=0.009) were independent prognostic factors for OS. Multivariate analysis showed that tumor stage (HR =3.213, 95% CI: 1.437-7.184, P=0.004), tumor grade (HR =6.102, 95% CI: 2.664-13.976, P<0.001) and TSR (HR =2.653, 95% CI: 1.063-6.621, P=0.03) were independent prognostic factors for CSS. Multivariate analysis showed that tumor stage (HR =4.805, 95% CI: 2.677-8.624, P<0.001), Conclusions: TSR is a new independent prognostic risk factor for ccRCC patients. The assessment of TSR is simple and cost-effective, and it is a useful supplement added to the pathological evaluation system.

To develop a 3D scoring system of tumor anatomy and intrarenal relationship for assessing surgical complexity and outcomes of robot-assisted partial nephrectomy (RAPN). We prospectively enrolled patients with a renal tumor who had a 3D model and underwent RAPN between Mar 2019 and Mar 2022. The ADDD nephrometry consisted of the contact surface area between tumor and parenchyma (A), the depth of tumor invasion into the renal parenchyma (D1), the distance from tumor to the main intrarenal artery (D2), and to the collecting system (D3). The primary outcomes included perioperative complication rate and trifecta outcome (WIT ≤ 25 min, negative surgical margins, and no major complications). We enrolled a total of 301 patients. The mean tumor size was 2.93 ± 1.44 cm. There were 104 (34.6

目的:总结采用国产康多内窥镜手术机器人系统行经腹膜外根治性前列腺切除及尿道周围全重建术的临床应用经验,初步评价其安全性和有效性.方法:前瞻性收集2021年5月20日-2021年6月20日于本中心接受康多内窥镜手术机器人经腹膜外根治性前列腺切除及尿道周围全重建术的患者的临床资料.描述手术过程,观察记录手术时间、出血量、住院天数、围术期并发症、术后病理、术后血清前列腺特异性抗原(PSA)及拔除尿管后控尿情况,将24 h使用尿垫≤1片或24 h漏尿量≤20 g定义为完全自主控尿.结果:本研究纳入6例患者,平均年龄为65(58～72)岁,平均体重指数为25.3(20.8～28.0)kg/m2,平均前列腺体积为47.3(27.0～86.0)mL.术前平均前列腺特异性抗原(PSA)为10.51(6.50～17.98)ng/mL.穿刺病理示:Gleason评分6分1例,7分5例.临床分期:T2b期2例,T2c期4例.既往有腹盆部手术史者2例(均为阑尾切除术).6例手术均由单一术者完成,术中无并发症或器械相关不良事件发生.平均手术时间138(120～154)min,平均机械臂对接时间5.7(2.5～9.8)min,平均机械臂腔内操作时间为96(82～116)min,平均膀胱颈与尿道吻合时间为15.9(12.2～25.7)min,平均术中出血量为85(10～200)mL.术后平均住院时间为6(4～10)d,所有患者均无Clavien-DindoⅡ～V级并发症出现.术后组织病理示:Gleason评分7分者5例,9分者1例,病理分期T2a、T2c和T3a期各2例,切缘阳性1例.术后1个月平均PSA为 0.014(0.007～0.033)ng/mL.所有患者尿管均留置2周,拔除尿管后48 h,3例患者完全自主控尿;拔管后1周,所有患者控尿能力较前增强,3例患者自主控尿;拔管后1个月,所有患者均完全自主控尿.结论:国产康多内窥镜手术机器人系统用于施行经腹膜外根治性前列腺切除及尿道周围全重建术具有良好的安全性和有效性,术后短期随访手术效果满意.

Background::The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system.Methods::From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed.Results::A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively.Conclusion::The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.

You have accessJournal of UrologyCME1 Apr 2023MP68-10 ROBOTIC UROLOGIC SURGERY USING THE KANGDUO-SURGICAL ROBOT-01 SYSTEM: A PROSPECTIVE COHORT STUDY OF 100 CONSECUTIVE CASES Shengwei Xiong, Shubo Fan, Silu Chen, Kunlin Yang, Zhongyuan Zhang, Cheng Shen, Liqun Zhou, and Xuesong Li Shengwei XiongShengwei Xiong More articles by this author , Shubo FanShubo Fan More articles by this author , Silu ChenSilu Chen More articles by this author , Kunlin YangKunlin Yang More articles by this author , Zhongyuan ZhangZhongyuan Zhang More articles by this author , Cheng ShenCheng Shen More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The purpose of this study is to present our single center experience in urological procedures using the KD-SR-01 system. METHODS: From August 2020 to July 2022, consecutive urologic procedures were performed using the KD-SR-01 system at Peking University First Hospital. The clinical features, perioperative data, and follow-up outcomes of the enrolled patients were collected and analyzed prospectively. RESULTS: A total of 100 consecutive patients (64 men and 36 women, median age 53 (range 21-75) years) were recruited. Twenty-eight patients underwent partial nephrectomy (PN), 36 patients underwent urinary tract reconstruction (including 21 pyeloplasty, 3 ureteral reconstruction and 12 ureterovesical reimplantation (UR)), and 36 patients were performed with radical prostatectomy (RP). Twenty RPs were performed in intraperitoneal approach, another 16 RPs in the extraperitoneal approach. The median operative time for PN was 65 min, for pyeloplasty was 157 min, for UR was 142.5 min, and for RP was 135.5 min. The median intraoperative blood loss was 10 mL, for pyeloplasty was 10 mL, for UR was 20 mL, and for RP was 50 mL. All procedures were successfully completed without conversion to laparoscopic or open surgery, and there were no major complications (Clavien-Dindo grade≥III) in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margins (PSM) were not noted in all patients. The overall PSM rate of RP was 36.1% (13/36), and the rate of urinary continence recovery at 1 month after catheter removal was 88.9% (32/36). The surgical success rate of pyeloplasty was 95.2% (20/21) at a median follow-up of 19 months. CONCLUSIONS: The KD-SR-01 system is feasible, safe, and effective for most urologic procedures according to our single center experience. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e956 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shengwei Xiong More articles by this author Shubo Fan More articles by this author Silu Chen More articles by this author Kunlin Yang More articles by this author Zhongyuan Zhang More articles by this author Cheng Shen More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective: To compare the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RARP) performed using the KangDuo surgical robot system to the da Vinci Si robotic system in clinically localized prostate cancer (KD-RARP vs DV-RARP). Methods: A total of 16 patients underwent extraperitoneal KD-RARP performed by a single experienced surgeon using the KangDuo surgical robot system between May 2021 and August 2021. The data were prospectively collected. The most recent 16 cases of extraperitoneal DV-RARP performed in 2021 by the same surgeon were selected from a prospectively maintained database for comparison to prevent operator variability. Preoperative, perioperative, and postoperative data were collected and compared between the two groups. Results: No significant difference was noted between the two groups in terms of basic clinical characteristics. All operations were performed successfully without open or traditional laparoscopic conversion. KD-RARP had a significantly longer operation time compared with DV-RARP (127 [107-159] vs 70.5 [54-90] minutes, p < 0.001). No significant differences between the two groups were observed in neurovascular bundle sparing, estimated blood loss, postoperative hospital stay duration, complications, positive surgical margins, biochemical recurrence, and continence recovery 3 months after catheter removal. Conclusions: RARP using the KangDuo surgical robot system achieved similar short-term oncological and functional outcomes with a disadvantage in operation time compared with the da Vinci Si robotic system. A multicenter randomized clinical trial with a larger sample size is needed for more experience.

You have accessJournal of UrologyCME1 Apr 2023PD07-06 RENAL TUMOR PLANAR EXTENSION IN THREE-DIMENSIONAL MODEL AS A NOVEL TECHNIQUE FOR PREOPERATIVE ASSESSMENT OF ROBOTIC PARTIAL NEPHRECTOMY Xinfei Li, Kunlin Yang, Xiaoteng Yu, Zhongyuan Zhang, Cuijian Zhang, Lin Cai, Zheng Zhang, Cheng Shen, Jin Tao, Dapeng Wu, Xuepei Zhang, Hailong Hu, Liqun Zhou, and Xuesong Li Xinfei LiXinfei Li More articles by this author , Kunlin YangKunlin Yang More articles by this author , Xiaoteng YuXiaoteng Yu More articles by this author , Zhongyuan ZhangZhongyuan Zhang More articles by this author , Cuijian ZhangCuijian Zhang More articles by this author , Lin CaiLin Cai More articles by this author , Zheng ZhangZheng Zhang More articles by this author , Cheng ShenCheng Shen More articles by this author , Jin TaoJin Tao More articles by this author , Dapeng WuDapeng Wu More articles by this author , Xuepei ZhangXuepei Zhang More articles by this author , Hailong HuHailong Hu More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe a tumor planar extension technique in three-dimensional (3D) model and assess its practicability in robot-assisted partial nephrectomy (RAPN). METHODS: A total of 231 patients with a renal tumor who underwent RAPN between Mar 2019 and Mar 2022 was prospectively enrolled. The 3D model was obtained based on enhanced CT urography. The tumor plane was extended equidistantly (10 mm) according to the original shape. The patients were divided into the collecting system involvement (CSI) group and the collecting system negative (CSN) group based on the relationship between the extended plane and the collecting system. The evaluation indicators included operative time, ischemia time, positive margin, major complication, and trifecta outcome (negative margin, ischemic time ≤25min, no major complication). RESULTS: The tumor diameter was 2.9 (0.8-10.0) cm. Median PADUA score was 8 (6-15). There were 173 and 58 patients in CSN and CSI groups, respectively. The operative time was 110.3±36.2 and 116.9 ± 36.6 min in CSN and CSI groups (p=0.228). The ischemic time in CSI group was significantly longer than that in CSN group (26.7±10.0 vs 21.0 ± 7.8 min, p<0.001). The patients in CSI group had a higher positive margin rate (1.72% vs. 0.58%) and higher risk of complications (8.62% vs 5.78%), but there was no statistical significance. Patients in CSI group whose ischemia time greater than 25 min was significantly more than that in CSN group (44.83% vs 21.39%, p=0.001). The failure rate in trifecta outcome in CSI group was significantly higher (46.55% vs 24.42%, p=0.003). The area under ROC curve in predicting trifecta outcome was 0.599 (p=0.017) based on the relationship between the tumor planar extension and the collecting system. CONCLUSIONS: The 3D tumor planar extension is a novel technique for tumor anatomy assessment and helps predict surgical outcomes of RAPN. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e164 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinfei Li More articles by this author Kunlin Yang More articles by this author Xiaoteng Yu More articles by this author Zhongyuan Zhang More articles by this author Cuijian Zhang More articles by this author Lin Cai More articles by this author Zheng Zhang More articles by this author Cheng Shen More articles by this author Jin Tao More articles by this author Dapeng Wu More articles by this author Xuepei Zhang More articles by this author Hailong Hu More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...