Author(s)

Ovidiu-Spiru Barnoiu^1*, F. J. Baron², T. Sæter³, A. O. Tysland¹, A. Andersen⁴

¹Department of Urology, Sorlandet Hospital, Kristiansand, Norway.
²Department of Biostatistics, University of Malaga, Malaga, Spain.
³Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁴Department of Urology, Sorlandet Hospital, Arendal, Norway.

Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. 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 < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.

Intraoperative Complications, Laparoscopic Partial Nephrectomy, Prediction, Trifecta

Barnoiu, O. , Baron, F. , Sæter, T. , Tysland, A. and Andersen, A. (2021) Prediction of Intraoperative Trifecta Achievement during Laparoscopic Partial Nephrectomy. Open Journal of Urology, 11, 6-16. doi: 10.4236/oju.2021.111002.