#0823

3D Laparoscopy is Better than 2D in Achieving Pentafecta in Nephron-Sparing Surgery for RCC.

A. Seregin¹, R. Tarasov¹, G. Aleshichev¹, O. Loran¹, D. Pushkar¹

¹Moscow Urology Center, Botkin Hospital, Russian Medical Academy of Continuous Professional Education, Urology, Moscow, Russia

Introduction:

The technical evolution of partial nephrectomy (PN) nowadays is aimed at performing nonischemic sutureless minimal-margin nephron sparing surgery. The aim of our study was to evaluate possible advantages in performing three-dimensional (3D) laparoscopic partial nephrectomy with respect to functional outcomes.

Material and methods:

This study was a retrospective analysis of 180 contemporary patients undergoing PN at a tertiary academic institution between January 2019 and December 2023 with minimal follow-up of one year. Consecutive consented patients were grouped into two cohorts: group 1, where standard two-dimensional (2D) laparoscopic PN was performed (n = 100) and group 2, which had 3D PN (n = 80). Mean RENAL score was similar between groups (6.5 and 7.4, p = 0.4). All surgeries were performed by experienced laparoscopic (more then 300 PN cases) urologist. Primary outcomes assessed the benefits of application 3D technology in laparoscopic completely unclamped, minimal-margin PN; short-term changes in estimated glomerular filtration rate (eGFR); and pentafecta achievement (negative surgical margins, no postoperative complications, warm ischemia time ≤25 minutes, over 90% estimated glomerular filtration rate (eGFR) preservation and no chronic kidney disease stage progression 1 year after surgery).

Results:

Demographic data were similar among groups. The intended nonischemic sutureless minimal-margin nephron sparing technique was performed in 65% of 2D PN and 88% of 3D PN (p=0,001). The rate of pentafecta was better in 3D PN (74%) vs 2D PN (62%) (p = 0.01). In addition, 3D PN group had less blood loss (200 and 120ml; p = 0.02), whereas transfusion rates, operative time and 30-d complication rates were similar. At 1-mo postoperatively, median percentage reduction in eGFR (10.4% and 5,6%; p = 0.3) and new-onset CKD stage >3 (23% and 16%; p = 0.02) were similar. Study limitations included retrospective analysis, small sample size, and short follow-up.