Outcomes in robot-assisted partial nephrectomy for imperative vs elective indications

Jo Lynn S. Tan, Niranjan Sathianathen, Marcus Cumberbatch, Prokar Dasgupta, Alexandre Mottrie, Ronney Abaza, Koon Ho Rha, Thyavihally B. Yuvaraja, Dipen J. Parekh, Umberto Capitanio, Rajesh Ahlawat, Sudhir Rawal, Nicolò M. Buffi, Ananthakrishnan Sivaraman, Kris K. Maes, Gagan Gautam, Francesco Porpiglia, Levent Turkeri, Mahendra Bhandari, Benjamin ChallacombeJames Roscoe Porter, Craig R. Rogers, Daniel A. Moon

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Objectives: To assess and compare peri-operative outcomes of patients undergoing robot-assisted partial nephrectomy (RAPN) for imperative vs elective indications. Patient and Methods: We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien–Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. Results: After propensity-score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien–Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day-1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). Conclusion: We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications.

Original languageEnglish
Pages (from-to)30-35
Number of pages6
JournalBJU International
Issue numberS3
Publication statusPublished - 2021 Dec

Bibliographical note

Funding Information:
We thank the VCQI.

Funding Information:
James R. Porter and Alexander Mottrie have received honoraria from Intuitive Surgical Inc. (Sunnyvale, CA, USA). Ronney Abaza reports grants from Conmed Inc., grants from Intuitive Surgical Inc., outside the submitted work, and educational programme support from Intuitive Surgical Inc. All other authors have no conflict of interest.

Publisher Copyright:
© 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd

All Science Journal Classification (ASJC) codes

  • Urology


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