不同達文西機器手臂系統對於部分腎臟切除手術術後達成「三贏（Trifecta）」及
「五贏（Pentafecta）」之影響
陳至亨、洪健華、周博敏、黃國皓、王碩盟、黃昭淵
國立台灣大學附設醫院 泌尿部
The effects of different da Vinci surgical systems on Trifecta and Pentafecta rates
for robot-assisted laparoscopic partial nephrectomy
Chih-Heng Chen, Jian-Hua Hong, Po-Ming Chow, Kuo-How Huang,
Shuo-Meng Wang, Chao-Yuan Huang
Department of Urology, National Taiwan University Hospital
Purpose: Robot-assisted partial nephrectomy (RaLPN) has comparable oncological outcomes to open and laparoscopic surgery. The fourth-generation da Vinci surgical systems, the Xi platform, was introduced in 2014 and provides advantages to some complex procedures. However, comparison studies regarding the perioperative outcomes between da Vinci platform Xi and Si for partial nephrectomy were sparse. We retrospectively reviewed and compared the Trifecta and Pentafecta rates between the different robotic surgical platforms.
Materials and Methods: Between April 2012 and August 2019, 343 patients received RaLPN at our institution, including 227 using the Si platform and 116 using the Xi platform. The Pentafecta achievement is defined as trifecta (warm ischemia time <30 minutes, negative surgical margin, and absence of significant perioperative complications) with addition of over 90% estimated glomerular filtration rate (eGFR) preservation, and no chronic kidney disease upgrading at 6 months after surgery. Continuous variables were analyzed using Mann-Whitney U test; whereas Chi-square and Fisher’s exact test were performed for categorical variables. Multivariate logistic regression analysis was conducted to identify the predictors of Trifecta and Pentafecta achievement.
Results: Baseline demographic and clinical tumor features were similar between both groups. Both the Trifecta and Pentafecta achievement rate were higher in the Xi group than the Si group ((52.6% vs. 25.6%, P < 0.001 for the Trifecta; 41.1% vs. 19.8% for the Pentafecta, P < 0.001 ,respectively). Besides, significantly shorter warm ischemia time (19 vs 28 mins, P < 0.001), console time (137 vs 169 mins, P < 0.001), and total operative time (196 vs 227 mins, P < 0.001) were found in Xi group compared to the Si group. There were no obvious differences in the complication rates and length of hospital stay between groups. Multivariate regression model demonstrated that male patients, no history of hypertension, low complexity by RENAL nephrometry score, and patients undergoing RaLPN by Xi platform were statistically associated with better Pentafecta and Trifecta achievement rate.
Conclusions: In summary, patients undergoing RaLPN with the da Vinci Xi platform obtained higher Trifecta and Pentafecta rates than those with the Si platform. The use of the Xi platform also significantly reduced the operative times and had similar complication rates with the Si platform. Further prospective, multi-institutional randomized controlled trials are required to determine the improvement of outcomes by the da Vinci Xi platform.