Feasibility And Safety In Application To The Four-arm Retroperitoneal Da Vinci Xi System Assisted Partial Nephrectomy

Objective:To analyze the feasibility and safety of applying four arms for Da Vinci Xi-assisted partial nephrectomy by retroperitoneal approach.Methods:From August 2019 to October 2021,we retrospective 46 patients who underwent robot-assisted partial nephrectomy in our hospital.18 patients used four arms via the transperitoneal approach,15 patients used four arms via the retroperitoneal approach,and 13 patients used three arms via the retroperitoneal approach.Respectively,the preoperative baseline data,intraoperative related indicators,perioperative related indicators,and 3-month postoperative follow-up results were compared of four-arm TP-RAPN and RP-RAPN,three-arm RP-RAPN,and four-arm RP-RAPN,four-arm RP-RAPN ventral and dorsal.Results:All patients completed the surgery successfully.There was no intraoperative change to open surgery.The pathological results showed a negative tumor margin.There were no serious complications in the groups of retroperitoneal.One of the transperitoneal had ileus after the operation.Comparing the baseline data of three-arm RP-RAPN with four-arm RP-RAPN and four-arm TP-RAPN with RP-RAPN,there was no statistically significant difference(P>0.05).Comparing intraoperative parameters,the four-arm RP-RAPN group had a shorter ischemia time(25.53±3.96min vs.28.62±2.79min,P=0.027),less estimated blood loss(107.3±31.95ml vs.136.2±34.04ml,P=0.029),and longer surgical onboard time(26.33±5.98min vs.22.31±3.15min,P=0.039).Comparison of postoperative renal function indicators,the group of four-arm RP-RAPN has less 24-hour postoperative e GFR reduction(18.03ml/min·1.73m~2 vs.31.11ml/min·1.73m~2,P=0.041),less postoperative 24-hour creatinine elevations(15.02μmol/L vs.27.81μmol/L,P=0.049),and more 3-month postoperative retention rate(90.3%vs.76.1%,P=0.036),which was significantly superior to postoperative renal function protection.There was no significant difference in postoperative tube drainage time,postoperative hospital stay,postoperative complications,and total hospital costs(P>0.05).Analyzing the four-arm RP-RAPN group versus the TP-RAPN group,the RP group have differences in console operation time(112.5±23.79min vs.126.4±14.9min,P=0.048),postoperative tube drainage time(3d vs.4d,P<0.001),postoperative hospital stay(7d vs.8d,P=0.003),postoperative complication rate(40.0%vs.77.8%,P=0.027)and total hospitalization cost($58,524±5085 vs.$63,225±5,104,P=0.013),all differences have statistically significant.There was no significant difference between ventral and dorsal four-arm RA-RAPN cases in console operation time,warm ischemia time,estimated blood loss,and 24-hour postoperative e GFR reduction rate(P>0.05).Results of correlation analysis,the tumor diameter,and R.A.N.E.L score have significant correlation with the console operation time,warm ischemia time,and estimated blood loss of four-arm RP-RAPN(P<0.05).Conclusion:The four-arm RP-RAPN is feasible,and the trocar site’s safety is possible.The retroperitoneal approach has obvious advantages in postoperative recovery and reducing the incidence of complications compared with the transperitoneal approach.Compared with three-arm RP-RAPN,the application of four-arm can also obtain less intraoperative blood loss and better renal function.