Development of Patient-Specific Nomogram to Assist in Clinical Decision-Making for Single Port Versus Multi-Port Robotic Partial Nephrectomy: A Report from the Single Port Advanced Robotic Consortium.

Abstract

Objective: To develop a patient-specific algorithm to better guide clinical decision-making when considering between single port (SP) and multi-port (MP) robotic partial nephrectomy (RPN). Materials and Methods: A retrospective review was performed on the institutional review board-approved, prospectively maintained multi-institutional database of the Single Port Advanced Research Consortium to identify all consecutive patients who underwent SP and MP-RPN between 2019 and 2023. Baseline clinicodemographic variables were used to identify the significant predictors of SP-RPN. The significant variables were used to construct a nomogram to predict the likelihood of SP vs MP-RPN. Results: Of the 1021 patients included in our analysis, 189 (18.5%) and 832 (81.5%) underwent SP and MP-RPN, respectively. Statistically significant predictors of SP-RPN included a lower comorbidity profile, a significant abdominal surgical history as characterized by a higher Hostile Abdomen Index, as well as tumors of lower complexity. The nomogram generated using the aforementioned variables demonstrated a reasonable performance with an area under the curve of 0.79. An optimal cutoff point was determined, with likelihood ratios above 0.12 indicating a preference for SP-RPN. Of note, all SP-RPN cases that scored above the 0.12 cutoff exhibited improved perioperative outcomes, including shorter ischemia time and less intraoperative blood loss. Conclusions: In this study, we have devised a novel patient selection nomogram aimed at enhancing clinical decision-making within the expanding repertoire of RPN approaches. The findings highlighted in this study offer valuable guidance to facilitate appropriate patient selection and thereby ensuring favorable perioperative outcomes associated with RPN procedures.