TITLE:
Prediction of Intraoperative Trifecta Achievement during Laparoscopic Partial Nephrectomy
AUTHORS:
Ovidiu-Spiru Barnoiu, F. J. Baron, T. Sæter, A. O. Tysland, A. Andersen
KEYWORDS:
Intraoperative Complications, Laparoscopic Partial Nephrectomy, Prediction, Trifecta
JOURNAL NAME:
Open Journal of Urology,
Vol.11 No.1,
January
27,
2021
ABSTRACT: Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) Methods: We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. Results: The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. Conclusion: We have defined an intraoperative Trifecta concept as the achievement of EBL