Indian Journal of Urology Users online:1525  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
LETTER TO EDITOR
Year : 2023  |  Volume : 39  |  Issue : 1  |  Page : 79-80
 

Re: Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, et al. Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study. Indian J Urol 2022;38:288-95


Department of Uro-Oncolgy and Robotics, Kokilaben Hospital, Mumbai, Maharashtra, India

Date of Submission26-Oct-2022
Date of Acceptance01-Dec-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Santosh Waigankar
Department of Uro-Oncolgy and Robotics, Kokilaben Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_382_22

Rights and Permissions

 

How to cite this article:
Kamath S, Waigankar S, Yuvaraja T B. Re: Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, et al. Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study. Indian J Urol 2022;38:288-95. Indian J Urol 2023;39:79-80

How to cite this URL:
Kamath S, Waigankar S, Yuvaraja T B. Re: Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, et al. Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study. Indian J Urol 2022;38:288-95. Indian J Urol [serial online] 2023 [cited 2023 Jan 28];39:79-80. Available from: https://www.indianjurol.com/text.asp?2023/39/1/79/365900


We read with great interest the article by Sharma et al.[1] Robotic platforms with improved dexterity and three-dimensional vision make partial nephrectomy feasible and attainment of trifecta even in complex renal masses.[2] The authors have done a commendable job in compiling this data and preparing a comprehensive manuscript. However, we did find a few lacunae in the data obtained and the statistical analysis performed which could further help in case the authors wished to perform a prospective observational study in future on similar lines.

The study includes multiple institutes across the globe. Therefore, it would have been worthwhile to tabulate the variables of each of these institutions individually and evaluate the varying warm ischemia times, surgical margins, and complications. Furthermore, the data on the breach of pelvicalyceal system and need for stenting has a significant impact on the perioperative outcome which should have been considered in the data set. The authors have utilized the VCQI database maintained from 2014 to 2020. Data for hilar and completely endophytic tumors are lacking from the database. This could be a separate subset among the complex renal masses where attaining the trifecta possess a challenge.

The study mentions warm ischemia time to be the most significant factor among the trifecta to be affected globally. Apart from the tumor variables described, surgeon factors which also have a significant impact on the outcomes is missing as mentioned in the limitations. This could have been overcome by equating all the baseline patient variables and tumor variables and then performing a propensity score match analysis for the perioperative outcomes of each institute which could account for the surgeon and institution factors. Propensity analysis could have been done on similar lines as done in a similar study in this journal for hilar tumors.[3]

An article published in 2016 also suggests that a single cut off value of warm ischemia time could not predict the long-term functioning of the kidney, which could have been assess by evaluating the means of warm ischemia time in the logistic regression.[4] On the flip side, the authors could have looked into the implications of each factor of PADUA score and individually assessed in the regression analysis. This would have minimized the bias that occurs in retrospective observational studies as done in a previous study using the same database in 2017.[5]

The above limitations in the study may dampen the impact of this global study and its influence on the practice of robotic partial nephrectomy.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, et al. Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti collective quality initiative database study. Indian J Urol 2022;38:288-95.  Back to cited text no. 1
  [Full text]  
2.
Wang L, Lee BR. Robotic partial nephrectomy: Current technique and outcomes. Int J Urol 2013;20:848-59.  Back to cited text no. 2
    
3.
Tyagi S, Sharma G, Bora GS, Mavuduru RS, Sharma AP, Devana SK, et al. Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy for hilar versus nonhilar tumors: A propensity-matched analysis. Indian J Urol 2021;37:318-24.  Back to cited text no. 3
  [Full text]  
4.
Mir MC, Pavan N, Parekh DJ. Current paradigm for ischemia in kidney surgery. J Urol 2016;195:1655-63.  Back to cited text no. 4
    
5.
Schiavina R, Novara G, Borghesi M, Ficarra V, Ahlawat R, Moon DA, et al. PADUA and R.E.N.A.L. Nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: Analysis of the Vattikuti global quality initiative in robotic urologic surgery (GQI-RUS) database. BJU Int 2017;119:456-63.  Back to cited text no. 5
    




 

Top
Print this article  Email this article
 

    

 
   Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (349 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed270    
    Printed4    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal

Fosfocin