The Application Of Arterial Based Complexity (ABC) Scoring System To Access The Complication Of Laparoscopic Partial Nephrectomy

Objection:To access the Arterial Based Complexity (ABC) scoring system to predict complexity of LPN and the relationship between different scores and estimated blood loss, warm ischemia time, operation time.Methods:Four readers independently scored contrast-enhanced computed tomography images of 70 patients who underwent LPN. Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Category 1 included tumors involving only the renal cortex, thus encompassing interlobular and arcuate arteries. Category 2 included tumors originating from or extending to the renal medulla and reaching the virtual line connecting the tip of the renal papillae, therefore requiring transection of the interlobar arteries. Renal masses extending into the renal sinus towards the central collecting system and involving the segmental arteries and their branches were categorized as 3S. Tumors in proximity of or involving the renal hilar vessels were categorized as 3H. Scores of 1,2,3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN. Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Logistics regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss,operation time.Results:Pairwise comparisons of readers’score assignments were significantly correlated; average kappa= 0.492 across all reader pairs. The average proportion of exact matches was 65%. Logistics regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and warm ischemia time and estimated blood loss.Conclusions:The ABC scoring system for LPN is intr(?) demonstrated good correlation with perior (?)dity. The ABC scoring system is a novel anato (?) developed to help patients and doctors complexity of renal masses and predict the outcomes of kidney surgery.