Clinical Implications for da Vinci SP Partial Nephrectomy in High-Complexity Tumors: Propensity Score-Matching...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Partial nephrectomy is a standard treatment for small renal masses.
• Robotic surgery has been adapted for single-site approaches to minimize invasiveness.
• Comparing different robotic platforms for single-site partial nephrectomy is crucial for optimizing outcomes.

Purpose of the Study:

• To compare surgical outcomes between robot-assisted laparoendoscopic single-site (R-LESS) surgery using da Vinci Si/Xi and the da Vinci SP system for partial nephrectomy.
• To evaluate the feasibility and effectiveness of the da Vinci SP system in true single-site robotic partial nephrectomy.

Main Methods:

• A retrospective review of 66 partial nephrectomies performed via a single-site robotic approach from 2008 to 2020.
• 44 cases used da Vinci Si/Xi (R-LESS group), and 22 used da Vinci SP (SP group).
• 1:1 propensity score matching was employed to compare surgical outcomes between the two groups.

Main Results:

• While median operation time was longer in the R-LESS group (180 vs 155 minutes), warm ischemic time was comparable.
• Estimated blood loss was significantly higher in the R-LESS group (215 vs 20 mL).
• The SP group showed a shorter operation time for moderate- to high-complexity tumors (172 vs 200 minutes), with similar trifecta achievement rates (63.6%).

Conclusions:

• Both R-LESS and da Vinci SP are feasible for single-site robotic partial nephrectomy.
• The da Vinci SP platform enables true single-site surgery with a wider workspace and improved performance.
• The SP method is particularly advantageous for managing complex renal tumors due to shorter operation times.