Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta

Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta Jacob O’Hara, Pranesh Rajendran, Ji Whae Choi, Laurence Hou, Simon Gelman, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9153976/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Evidence from the literature suggests that patients with more complex tumors are less likely to achieve the surgical trifecta—defined as negative margins, ischemia time under 25 minutes, and the absence of Clavien-Dindo grade III or higher postoperative complications. The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes. Methods Our institution’s IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were estimated using Wilson score 95% confidence intervals. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size. Results The SP RAPN (N = 102) cohort included fewer male patients and had lower BMI, nephrometry scores, and tumor sizes compared to the MP cohort (N = 494). Trifecta achievement did not differ significantly between the SP (76%) and MP (80%) groups ( p = 0.46). The odds of trifecta achievement were not significantly influenced by surgical platform choice (p = 0.052). Among the factors we analyzed, only nephrometry score was significantly associated with trifecta achievement, while surgical approach showed no significant association. Conclusion We conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity. Single-port multi-port partial nephrectomy trifecta robotic surgery Introduction Renal cancer poses a significant disease burden, attributing 4% of all global cancer diagnoses with 434,840 new cases and 155,953 deaths in 2022. Incidence and mortality are expected to rise by 72% and 96% for incidence and mortality respectively in the year 2050 [ 1 , 2 ]. Renal cell carcinoma (RCC) accounts for 90% of all renal cancers, with prior large database studies staging most masses as T1, likely due to incidental findings on imaging studies [ 3 , 4 ]. Guidelines strongly recommend nephron-sparing surgery with partial nephrectomy (PN) as the primary curative treatment for localized RCC, as it is associated with better preservation of kidney function with no difference in cancer-specific survival compared with radical nephrectomy [ 5 , 6 ]. With the increased utilization of PN, particularly with the emergence of a robot-assisted partial nephrectomy (RAPN) approach, there was a need to standardize the assessment of post-operative outcomes across surgical techniques. The earliest concept of a surgical “trifecta” in urologic surgery was initially proposed for radical prostatectomy as a means to objectively compare post-operative outcomes following treatment for prostate cancer [ 7 , 8 ]. This idea was borrowed for PN in 2013 to assess post-operative renal function during a time of increasing tumor complexity. The trifecta was initially defined as the 3 outcomes of: negative cancer margin, minimal renal functional decrease (< 10% reduction in postoperative glomerular filtration rate [GFR]), and no urological complications [ 9 ]. As the trifecta continued to be adopted for studies assessing PN, the characterization of renal function and complications evolved to more precisely evaluate oncologic and functional outcomes. Recent studies now recommend this definition of trifecta as a quality benchmark: negative surgical margins, warm ischemia time 2 [ 10 ]. The trifecta outcome was utilized to compare open nephrectomy, laparoscopic nephrectomy, and RAPN, with variability seen in different studies likely due to the learning curve for achieving positive outcomes with RAPN [ 11 , 12 ]. Nevertheless, RAPN has emerged as the standard of care for low-stage tumors based on non-inferiority of trifecta outcomes [ 13 ]. The trifecta has also been used to identify factors that can predict the success of PN, with prior studies demonstrating that only tumor size and high complexity PADUA score are associated with a decreased probability of trifecta achievement [ 10 ]. The single-port (SP) approach for RAPN emerged in 2019 with the goal of reducing post-operative morbidity and improving cosmesis with a reduced number of incisions and improved surgical dexterity compared with the multi-port (MP) approach [ 14 ]. Prior studies have shown that the SP approach is safe and feasible with no difference to MP in complication rates, surgical margins, and postoperative kidney function. SP was shown to have superiority with shorter hospital stays, but at the cost of longer warm ischemia times and transfusion rates [ 15 – 17 ]. Further data on trifecta outcomes between these two approaches would validate the choice for an SP approach. Additionally, studies that evaluate the predictive power of nephrometry scores for trifecta outcomes in SP RAPN exist [ 18 ], but there are no studies that stratify these predictive tools between SP and MP surgical platforms. This study aims to evaluate the rate of achievement of trifecta during single-port and multi-port RAPN approaches at a high-volume institution. We hypothesized that some perioperative parameters (i.e. nephrometry score, BMI, and tumor size) are associated with a different likelihood of trifecta success and are influenced by surgical approach. The ability to better predict optimal surgical outcomes will help to guide surgical decision-making. Methods In this retrospective observational cohort study of prospectively gathered data, the trifecta outcome was defined as meeting all three criteria: negative surgical margin, ischemia time < 25 minutes, and 30-day Clavien-Dindo classification < Grade III. A total of 753 patients with RCC who underwent RAPN from 2017–2025 were identified in our institution's IRB-approved, prospective renal cancer database. Patients were stratified into cohorts based on SP and MP RAPN approach. Analysis was restricted to the complete-case set (N = 596) with non-missing surgical margin status, ischemia time, and nephrometry score (SP = 102, MP = 494). Continuous variables were summarized with mean (SD) and median (IQR), categorical with counts (%) and compared between groups using Wilcoxon rank sum test, Pearson’s Chi-squared test, and Fisher’s exact test, as appropriate. Trifecta rates by surgical platform group were estimated with Wilson (score) 95% confidence intervals. Multiple logistic regression models were used to explore associations between a binary trifecta outcome and platform group, age, sex, BMI, nephrometry score (categorical: 4–6, 7–9, 10–12), and tumor size. Alternatively, a stratified analysis was performed to see if the difference in rates of trifecta between MP and SP are different across the nephrometry score strata. Cochran–Mantel–Haenszel test was used to test the common odds ratio across the nephrometry score strata and the Breslow–Day test was used to test the heterogeneity of the odds ratios across strata. Results In the complete-case cohort, there were several differences between SP and MP groups. The proportion of female patients was greater in the SP group compared to the MP group (43% vs 33%; p = 0.046). Patients in the SP group had slightly lower median BMI (27.3 [24.2–32.0] vs 29.4 [25.9–33.6] kg/m²; p = 0.009), median nephrometry score (7 [ 5 – 9 ] vs 8 [ 7 – 9 ]; p < 0.001), and median tumor size (2.50 [1.80–3.50] vs 3.00 [2.20-4.00] cm; p < 0.001). Age was similar between SP and MP cohorts (62 [53–70] vs 62 [55–70] years; p = 0.38). See Table 1 . Table 1 Baseline characteristics for SP and MP cohorts. Perioperative outcomes were similar across cohorts with comparable margin positivity rates in SP vs MP groups (2.9% vs 3.6%, p > 0.99) and median warm ischemia time (16 [0–23] vs 17 [ 13 – 21 ] minutes, p = 0.15). Postoperative complications were likewise rare and comparable between the SP and MP cohort during the hospital stay (p = 0.81) and 30-day (p = 0.24) periods. See Table 2 . Characteristic SP, N = 102 MP, N = 494 p-value Age 0.38 1 Mean (SD) 60 (13) 62 (12) Median (IQR) 62 (53, 70) 62 (55, 70) Range 28, 82 23, 88 Gender, n (%) 0.046 2 Female 44 (43) 162 (33) Male 58 (57) 332 (67) BMI 0.009 1 Mean (SD) 28.5 (6.0) 30.1 (6.1) Median (IQR) 27.3 (24.2, 32.0) 29.4 (25.9, 33.6) Range 18.6, 48.9 10.1, 60.4 Missing 0 2 Nephrometry Score < 0.001 1 Mean (SD) 7 (2) 8 (2) Median (IQR) 7 (5, 9) 8 (7, 9) Range 4, 11 4, 12 Nephrometry Score Category, n (%) < 0.001 2 4–6 49 (48) 120 (24) 7–9 36 (35) 267 (54) 10–12 17 (17) 107 (22) Greatest Tumor Dimensions < 0.001 1 Mean (SD) 2.77 (1.29) 3.36 (1.71) Median (IQR) 2.50 (1.80, 3.50) 3.00 (2.20, 4.00) Range 0.30, 6.90 0.50, 13.00 Missing 0 2 1 Wilcoxon rank sum test 2 Pearson’s Chi-squared test Table 2 Perioperative outcomes of the SP and MP cohorts. Trifecta rates were high in both groups: SP 0.76 (95% CI 0.67–0.84) and MP 0.80 (95% CI 0.76–0.83), with an absolute difference of 0.03 (95% CI − 0.06 to 0.12; p = 0.457). By nephrometry category, the overall distribution among all 596 patients was 28.4% (4–6), 50.8% (7–9), and 20.8% (10–12). Within groups, row-wise percentages showed that SP patients who achieved the trifecta were more often in the lower-complexity stratum (4–6: 59.0%, 7–9: 30.8%, 10–12: 10.3%), whereas MP patients who achieved the trifecta were most commonly in 7–9 (54.8%) with 27.4% in 4–6 and 17.8% in 10–12. See Table 3 . Characteristic SP, N = 102 MP, N = 494 p-value Margin, n (%) > 0.99 1 Positive 3 (2.9) 18 (3.6) Negative 99 (97) 476 (96) Ischemia Time 0.15 2 Mean (SD) 14 (12) 17 (9) Median (IQR) 16 (0, 23) 17 (13, 21) Range 0, 45 0, 70 Hospital Stay Complications , n (%) 0.81 1 Grade I 3 (2.9) 19 (3.8) Grade II 1 (1.0) 14 (2.8) Grade III 0 (0) 5 (1.0) Grade IIIa 1 (1.0) 2 (0.4) Grade IIIb 0 (0) 4 (0.8) Grade IVa 0 (0) 2 (0.4) Grade V 0 (0) 1 (0.2) None 97 (95) 447 (90) 30-Day Complications , n (%) 0.24 1 Grade I 3 (2.9) 9 (1.8) Grade II 0 (0) 9 (1.8) Grade III 1 (1.0) 3 (0.6) Grade IIIa 1 (1.0) 2 (0.4) Grade IIIb 1 (1.0) 1 (0.2) Grade IVa 0 (0) 0 (0) Grade V 0 (0) 0 (0) None 96 (94) 470 (95) Trifecta Achievement , n (%) 78 (76) 394 (80) 0.46 3 1 Fisher’s exact test 2 Wilcoxon rank sum test 3 Pearson’s chi square test Table 2 The number and percentage of patients within each nephrometry score category (4–6, 7–9, and 10–12) stratified by surgical approach and by achievement of the trifecta. Percentages are calculated within each row so that each row sums to 100%. “Overall” rows represent totals within each surgical approach regardless of trifecta status, and the final row shows the combined distribution across all patients (N = 596). Platform Trifecta 4–6 7–9 10–12 Row total SP No 3 (12.5%) 12 (50.0%) 9 (37.5%) 24 (100%) SP Yes 46 (59.0%) 24 (30.8%) 8 (10.3%) 78 (100%) SP Overall 49 (48.0%) 36 (35.3%) 17 (16.7%) 102 (100%) MP No 12 (12.0%) 51 (51.0%) 37 (37.0%) 100 (100%) MP Yes 108 (27.4%) 216 (54.8%) 70 (17.8%) 394 (100%) MP Overall 120 (24.3%) 267 (54.0%) 107 (21.7%) 494 (100%) Sum Overall 169 (28.4%) 303 (50.8%) 124 (20.8%) 596 (100%) The Cochran–Mantel–Haenszel test controlling for nephrometry score strata estimated a common odds ratio of 1.6 (95% CI 0.93–2.75; p = 0.1144), indicating a nonsignificant overall tendency toward higher odds of trifecta in MP relative to SP after adjusting for nephrometry category. The Breslow–Day test found no evidence of heterogeneity of the surgical platform effect (MP vs. SP) across nephrometry score strata (p = 0.1995), indicating that the difference in trifecta rates between MP and SP does not change with increasing nephrometry score. In the multiple logistic regression, nephrometry score category was the only significant predictor of achieving the trifecta. Relative to 4–6, 7–9 had 63% lower odds (OR 0.37, 95% CI 0.19–0.68; p = 0.002) and 10–12 had 81% lower odds (OR 0.19, 95% CI 0.09–0.38; p < 0.001), suggesting a monotonic decrease in odds with increasing nephrometry score. MP showed a non-significant increase in odds of trifecta relative to SP (OR 1.72, 95% CI 0.98–2.97; p = 0.052). Age, sex, BMI, and tumor size showed no independent associations (p > 0.1). See Table 4 . Table 4 Results of multiple logistic regression modeling for factors predicted to impact trifecta achievement. Characteristic Model with interaction Model without interaction OR (95% CI) 1 p-value OR (95% CI) 1 p-value Platform SP — — MP 0.60 (0.13 to 2.00) 0.44 1.72 (0.98 to 2.97) 0.052 Age 1.00 (0.98 to 1.02) > 0.99 1.00 (0.98 to 1.02) 0.96 Gender Female — — Male 0.91 (0.58 to 1.42) 0.68 0.94 (0.60 to 1.45) 0.77 BMI 1.00 (0.97 to 1.03) 0.98 1.00 (0.97 to 1.03) 0.90 Nephrometry Score 4–6 — — 7–9 0.14 (0.03 to 0.51) 0.005 0.37 (0.19 to 0.68) 0.002 10–12 0.07 (0.01 to 0.27) < 0.001 0.19 (0.09 to 0.38) < 0.001 Greatest Tumor Dimensions 0.89 (0.78 to 1.01) 0.067 0.89 (0.79 to 1.01) 0.079 Platform * Nephrometry Score MP * 7–9 3.67 (0.87 to 19.5) 0.094 MP * 10–12 4.31 (0.85 to 26.5) 0.090 1 OR = Odds Ratio, CI = Confidence Interval Adding the surgical platform × nephrometry score category interaction did not significantly improve model fit (likelihood ratio test: ΔDeviance = 3.84, 2 df, p = 0.1465). Thus, there’s no strong evidence that the effect of surgical platform on trifecta differs by nephrometry category beyond the main-effects model. The results of logistic regression model without interaction term suggest that, after adjustment for the listed covariates, only nephrometry score was significantly associated with trifecta achievement. Relative to the reference 4–6 nephrometry score category, patients with 7–9 have 63% lower odds of trifecta achievement (OR = 0.37, 95% CI 0.19–0.68; p = 0.002) and those with nephrometry scores of 10–12 have 81% lower odds of trifecta achievement (OR = 0.19, 95% CI 0.09–0.38; p < 0.001), indicating a monotonic decrease in odds with increasing nephrometry complexity category. MP had non-significantly higher odds of trifecta outcome compared to SP (OR = 1.72, 95% CI 0.98–2.97; p = 0.052). Other covariates exhibited no evidence of independent association. Discussion The SP surgical platform was introduced in 2018 to provide a more minimally invasive option for surgery. Recent meta-analyses have demonstrated that SP RAPN is associated with shorter length of stay and estimated blood loss with no difference in postoperative complications or margin status compared to MP, though the effect on ischemia time is less agreed upon [ 15 – 17 ]. The surgical trifecta has long been a metric for categorizing PN according to margin status, ischemia time, and complications and trifecta outcomes. As a high-volume institution, we are invested in implementing technologies that are safer, more efficient, and improve outcomes for our patients, which is why we chose to evaluate the performance of the SP robot compared to the MP gold standard at our institution for the surgical trifecta of RAPN. There are several key takeaways from this study. First, that trifecta achievement is high in both SP and MP RAPN (76 vs 80%). Second, on regression analysis, the odds of achieving the trifecta are not independently associated with surgical platform choice (p = 0.052). Lastly, that increasing nephrometry score is the key negative predictor of trifecta achievement overall but that there is no difference in trifecta achievement in SP vs MP when adjusting for low, intermediate, and high nephrometry score tumors (OR 1.6, 95% CI 0.93–2.75; p = 0.1144). Trifecta outcomes are commonly reported in the partial nephrectomy literature, though studies comparing trifecta achievement between the SP and MP platforms are sparse. Licari et al found an SP trifecta achievement of 57% compared to 63% in the MP cohort (p = 0.8) in a small propensity matched study [ 19 ]. Very recently, a large multi-institutional propensity matched study found SP vs MP trifecta achievement was 68.8% vs 64.7% (p = 0.051) [ 20 ]. Our institutional data demonstrates similar or better rates compared to the literature. We hypothesize that the improved trifecta outcomes in both SP and MP may be associated with the high volume of nephron-sparing surgery performed at our institution as well as potentially higher rates of off-clamp partial nephrectomy, which results in zero ischemia time and heavily contributes to trifecta achievement. Although SP is relatively new and being more widely adopted, the literature and our data agree that the trifecta can be achieved with similar rates to MP. The results of this study are also notable because they help clarify patient selection for partial nephrectomy. Although the odds of achieving the surgical trifecta decrease as tumor complexity increases, there is not a differential impact in SP compared to MP, and surgeons can feel confident electing to utilize a more minimally invasive SP approach without sacrificing perioperative outcomes. With these findings in mind, it is still important to note that there is a learning curve for the SP robot. With a smaller workspace volume inherent to SP and technical differences compared to MP that stem from having multiple instruments in much closer proximity, the SP robot can present challenges for new adopters. As a result, surgeons should bear in mind that the trifecta outcomes we demonstrate in this study, as well as other studies reporting high trifecta achievement with SP, are a product of experience with this platform. Surgeons with less experience using SP should still carefully consider patient selection when adopting SP. The role of the R.E.N.A.L nephrometry score [ 21 ] in the achievement of trifecta outcomes is also well-founded in the literature, which is why we included it in our analysis. Zargar et al recently found on multivariate analysis of RAPN and laparoscopic partial nephrectomy (LPN) that nephrometry score 10–12 and tumor size were negative predictors of trifecta achievement. Interestingly, this study also found RAPN to be predictive of achieving the trifecta relative to LPN, though trifecta achievement in the LPN cohort was lower than is typically seen in the literature (77% vs 33%, p < 0.001) [ 12 ]. Bindayi et al demonstrated in a large group of open partial nephrectomy (OPN), LPN, and RPN patients that tumor size in addition to nephrometry score (OR 1.26, p = 0.007) were predictors of the trifecta on multivariate analysis [ 22 ]. Likewise, even more recent analysis of the R.E.N.A.L, PADUA, and SPARE scores found each to be predictive of trifecta achievement in SP RAPN, with the R.E.N.A.L score specifically predictive of the intermediate risk nephrometry score group (OR 0.462, 95% CI 0.233–0.899; p = 0.025) [ 18 ]. Studies examining trifecta outcomes in both SP and MP RAPN have pointed to tumor complexity as a key component of these outcomes, but these studies lack stratification of this effect according to these surgical platforms. To our knowledge, there is no study that stratifies this by SP and MP surgical platform, which is why we included this in our analysis. Our findings demonstrate similar results to the literature in that trifecta outcomes in RAPN are closely related to nephrometry score with the novel addition that there is no difference between the SP and MP platforms when adjusting for differences in nephrometry score. We acknowledge there are limitations to this study. First, although the data in this study was collected prospectively, the retrospective nature of the analysis and lack of randomization to surgical platform could introduce selection bias. Surgical platform choice was instead based on surgeon preference, which could also be a potential source of selection bias or confounding by indication. Second, our institution performs a high volume of RAPN and SP surgery, which could play a role in the comparable outcomes of our SP and MP cases. Likewise, surgeon experience could play a role in trifecta achievement and would not be quantified in this analysis. These findings should be validated with a multi-institutional cohort to capture a larger variety of SP experience and could consider incorporating surrogate measures for surgeon experience, both in general and with the SP robot specifically. Lastly, in our multivariate analysis we included both tumor size as well as the R.E.N.A.L nephrometry score, which already takes size into account. This could introduce a masking of the effect of either variable in the analysis, although similar methodology exists in the literature [ 12 , 22 ]. Future study should consider incorporating each element of the nephrometry score as its own variable in the multivariate analysis. Conclusion We conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity. Abbreviations ● BMI Body mass index ● GFR Glomerular filtration rate ● IQR Interquartile range ● LPN Laparoscopic partial nephrectomy ● MP Multi-port ● OPN Open partial nephrectomy ● OR Odds ratio ● PADUA Preoperative Aspects and Dimensions Used for an Anatomical evaluation ● PN Partial nephrectomy ● R.E.N.A.L Radius, Exophytic/endophytic, Nearness, Anterior/Posterior, Location ● RAPN Robot-assisted partial nephrectomy ● RCC Renal cell carcinoma ● SD Standard deviation ● SP Single-port ● SPARE Simplified PADUA Renal Declarations Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests: Authors Jacob O’Hara, Pranesh Rajendran, Ji Whae Choi, Laurence Hou, Simon Gelman, Aisha Kourouma, Mubashir S. Billah, and Nitin Yerram declare they have no financial interests. Ravi Munver serves as a consultant for PROCEPT BioRobotics and has received an educational grant from Boston Scientific. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc. Author Contribution: All authors contributed to the study conception and design. Material preparation and data collection were performed by JO, PR, JWC, and AK. Statistical analysis was performed by SG. The first draft of the manuscript was written by JO, PR, and JWC and all authors commented on previous versions of the manuscript. Critical revisions of the manuscript were made by JO, MB, MA, MS, and NY. All authors read and approved the final manuscript. Ethics Approval: This study received ethics approval with its IRB approval on 5/24/2017 (Pro2016-0680). Consent to Participate: Informed consent was obtained from all individual participants included in this study. Consent to Publish: Consent to publish was obtained from all individuals included in this study. References Larcher A, Campi R, Bex A et al (2025) Epidemiology of Renal Cancer: Incidence, Mortality, Survival, Genetic Predisposition, and Risk Factors. Eur Urol 88:341–358. https://doi.org/10.1016/j.eururo.2025.06.005 Cancer of the Kidney and Renal Pelvis - Cancer Stat Facts (2026) SEER n.d. https://seer.cancer.gov/statfacts/html/kidrp.html Pecoraro A, Palumbo C, Knipper S et al (2021) Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database-based Study. Eur Urol Focus 7:818–826. https://doi.org/10.1016/j.euf.2020.02.011 Lundstam S, Almdalal T, Rosenblad AK et al (2025) Is Partial Nephrectomy A Primary Option for Patients with T1b Renal Cell Carcinoma-A National Population-Based Study. Urol Res Pract 50:322–327. https://doi.org/10.5152/tud.2025.24081 Bex A, Ghanem YA, Albiges L et al (2025) European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update. Eur Urol 87:683–696. https://doi.org/10.1016/j.eururo.2025.02.020 Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow Up (2021) - American Urological Association n.d. https://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up#x15411 (accessed February 11, 2026) Eastham JA, Scardino PT, Kattan MW (2008) Predicting an optimal outcome after radical prostatectomy: the trifecta nomogram. J Urol 179:2207–2210 discussion 2210–2211. https://doi.org/10.1016/j.juro.2008.01.106 Shikanov SA, Zorn KC, Zagaja GP et al (2009) Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology 74:619–623. https://doi.org/10.1016/j.urology.2009.02.082 Hung AJ, Cai J, Simmons MN et al (2013) Trifecta in partial nephrectomy. J Urol 189:36–42. https://doi.org/10.1016/j.juro.2012.09.042 Bai N, Qi M, Shan D et al (2022) Trifecta achievement in patients undergoing partial nephrectomy: a systematic review and meta-analysis of predictive factors. Int Braz J Urol 48:625–636. https://doi.org/10.1590/S1677-5538.IBJU.2021.0095 Omidele OO, Davoudzadeh N, Palese M (2018) Trifecta Outcomes to Assess Learning Curve of Robotic Partial Nephrectomy. JSLS. ;22:e2017.00064. https://doi.org/10.4293/JSLS.2017.00064 Zargar H, Allaf ME, Bhayani S et al (2015) Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int 116:407–414. https://doi.org/10.1111/bju.12933 Calpin GG, Ryan FR, McHugh FT et al (2023) Comparing the outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a network meta-analysis. BJU Int 132:353–364. https://doi.org/10.1111/bju.16093 Berry JM, Hill H, Vetter JM et al Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023:1–7. https://doi.org/10.1007/s11701-023-01637-4 Nguyen TT, Ngo XT, Duong NX et al (2024) Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis. J Endourol 38:253–261. https://doi.org/10.1089/end.2023.0505 Hu A, Lv Z, Chen G et al (2024) Comparison of single-port versus multi-port robotic assisted partial nephrectomy: a systematic review and meta-analysis of perioperative and oncological outcomes. J Robot Surg 18:321. https://doi.org/10.1007/s11701-024-02066-7 Bang S, Yu J, Bae H et al (2024) Single-Port Versus Multi-Port Robotic Retroperitoneal Partial Nephrectomy: A Propensity Score-Matched Comparison. J Endourol 38:1353–1358. https://doi.org/10.1089/end.2024.0493 Carletti F, Valenzi FM, Tamborino F et al (2025) Predicting surgical outcomes in single-port robot-assisted partial nephrectomy: external validation and comparative analysis of PADUA, RENAL, and SPARE scores. World J Urol 43:707. https://doi.org/10.1007/s00345-025-06081-7 Licari LC, Bologna E, Franco A et al (2024) Single-port vs multi-port robot-assisted partial nephrectomy: A single center propensity score-matched analysis. Eur J Surg Oncol 50:108011. https://doi.org/10.1016/j.ejso.2024.108011 Soputro NA, Saxena S, Bamby J et al Single-port Robotic Retroperitoneal Partial Nephrectomy via Low Anterior Access: A Propensity-matched Comparative Analysis to Standard Transperitoneal Multiport Robotic Surgery from the Single Port Advanced Research Consortium (SPARC). Eur Urol Focus 2025:S2405-4569(25)00361-X. https://doi.org/10.1016/j.euf.2025.12.008 Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853. https://doi.org/10.1016/j.juro.2009.05.035 Bindayi A, Autorino R, Capitanio U et al (2020) Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group. Eur Urol Focus 6:982–990. https://doi.org/10.1016/j.euf.2019.02.010 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Apr, 2026 Reviews received at journal 08 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviewers invited by journal 30 Mar, 2026 Editor assigned by journal 24 Mar, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 17 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9153976","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":614590008,"identity":"e5b11991-d055-48eb-bde7-77048460aa4b","order_by":0,"name":"Jacob O’Hara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACxgYGBmYgnQBiP2ZgOECaFmZjorSAAEwLmzRRWpjbDz98XMBgk8c/+/Cz6sKcO3kM7L2PX+B1WE+asfEMhrRiiXNpZrdnbntWzMBz3MwCr5aGHDZpHobDiQ1nGMxu824DMiTS2Azwaul/A9Ey/wz7t2LitMyA2rLhDI8ZM1QL8wP8Wp4B/WKQlrjxDE+xNEhLG88xNnw6GAz7k4EhVmGTOO8M+8bPIC397G3MH/BqaQCRyG4HWsEmgU+LPDZB/LaMglEwCkbBiAMAxkhI7Lja+dcAAAAASUVORK5CYII=","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Jacob","middleName":"","lastName":"O’Hara","suffix":""},{"id":614590009,"identity":"d115f502-286b-46cf-9bcb-e89d8b8c7353","order_by":1,"name":"Pranesh Rajendran","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Pranesh","middleName":"","lastName":"Rajendran","suffix":""},{"id":614590010,"identity":"f149904d-a882-4fc3-b5bf-cbbdbe06ee0c","order_by":2,"name":"Ji Whae Choi","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ji","middleName":"Whae","lastName":"Choi","suffix":""},{"id":614590011,"identity":"0004b7a5-0b77-4dbe-a537-4eafd32d8869","order_by":3,"name":"Laurence Hou","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Laurence","middleName":"","lastName":"Hou","suffix":""},{"id":614590012,"identity":"6374f0d1-b232-419c-b8d6-6a26f0f63dae","order_by":4,"name":"Simon Gelman","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Gelman","suffix":""},{"id":614590013,"identity":"6ef8a247-e864-419d-b84f-cae49b1abc3b","order_by":5,"name":"Aisha Kourouma","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"","lastName":"Kourouma","suffix":""},{"id":614590014,"identity":"2eda08b5-f85f-4855-9f9a-8af410b59259","order_by":6,"name":"Mubashir S Billah","email":"","orcid":"","institution":"Hackensack University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Mubashir","middleName":"S","lastName":"Billah","suffix":""},{"id":614590015,"identity":"1c820319-fb46-4a4f-8069-d23566bede43","order_by":7,"name":"Ravi Munver","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ravi","middleName":"","lastName":"Munver","suffix":""},{"id":614590016,"identity":"9a4e8e93-1d66-4f43-8725-606bd8cf88ef","order_by":8,"name":"Mutahar Ahmed","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mutahar","middleName":"","lastName":"Ahmed","suffix":""},{"id":614590017,"identity":"c6eb10e0-08cb-4e56-82bd-39083923002a","order_by":9,"name":"Michael Stifelman","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Stifelman","suffix":""},{"id":614590018,"identity":"7d544f0e-a4b0-487e-9fa3-61e76d47cb4e","order_by":10,"name":"Nitin Yerram","email":"","orcid":"","institution":"Hackensack Meridian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Nitin","middleName":"","lastName":"Yerram","suffix":""}],"badges":[],"createdAt":"2026-03-18 03:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9153976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9153976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105905557,"identity":"041f20ad-a050-4ded-98c1-deb8dfaf555e","added_by":"auto","created_at":"2026-04-01 10:12:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":922140,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9153976/v1/5a281c39-b70d-4d53-9f0e-2f521470403e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRenal cancer poses a significant disease burden, attributing 4% of all global cancer diagnoses with 434,840 new cases and 155,953 deaths in 2022. Incidence and mortality are expected to rise by 72% and 96% for incidence and mortality respectively in the year 2050 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Renal cell carcinoma (RCC) accounts for 90% of all renal cancers, with prior large database studies staging most masses as T1, likely due to incidental findings on imaging studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Guidelines strongly recommend nephron-sparing surgery with partial nephrectomy (PN) as the primary curative treatment for localized RCC, as it is associated with better preservation of kidney function with no difference in cancer-specific survival compared with radical nephrectomy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. With the increased utilization of PN, particularly with the emergence of a robot-assisted partial nephrectomy (RAPN) approach, there was a need to standardize the assessment of post-operative outcomes across surgical techniques.\u003c/p\u003e \u003cp\u003eThe earliest concept of a surgical \u0026ldquo;trifecta\u0026rdquo; in urologic surgery was initially proposed for radical prostatectomy as a means to objectively compare post-operative outcomes following treatment for prostate cancer [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This idea was borrowed for PN in 2013 to assess post-operative renal function during a time of increasing tumor complexity. The trifecta was initially defined as the 3 outcomes of: negative cancer margin, minimal renal functional decrease (\u0026lt;\u0026thinsp;10% reduction in postoperative glomerular filtration rate [GFR]), and no urological complications [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As the trifecta continued to be adopted for studies assessing PN, the characterization of renal function and complications evolved to more precisely evaluate oncologic and functional outcomes. Recent studies now recommend this definition of trifecta as a quality benchmark: negative surgical margins, warm ischemia time\u0026thinsp;\u0026lt;\u0026thinsp;25 minutes, and no Clavien-Dindo complications\u0026thinsp;\u0026gt;\u0026thinsp;2 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The trifecta outcome was utilized to compare open nephrectomy, laparoscopic nephrectomy, and RAPN, with variability seen in different studies likely due to the learning curve for achieving positive outcomes with RAPN [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nevertheless, RAPN has emerged as the standard of care for low-stage tumors based on non-inferiority of trifecta outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The trifecta has also been used to identify factors that can predict the success of PN, with prior studies demonstrating that only tumor size and high complexity PADUA score are associated with a decreased probability of trifecta achievement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe single-port (SP) approach for RAPN emerged in 2019 with the goal of reducing post-operative morbidity and improving cosmesis with a reduced number of incisions and improved surgical dexterity compared with the multi-port (MP) approach [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Prior studies have shown that the SP approach is safe and feasible with no difference to MP in complication rates, surgical margins, and postoperative kidney function. SP was shown to have superiority with shorter hospital stays, but at the cost of longer warm ischemia times and transfusion rates [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Further data on trifecta outcomes between these two approaches would validate the choice for an SP approach. Additionally, studies that evaluate the predictive power of nephrometry scores for trifecta outcomes in SP RAPN exist [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], but there are no studies that stratify these predictive tools between SP and MP surgical platforms.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the rate of achievement of trifecta during single-port and multi-port RAPN approaches at a high-volume institution. We hypothesized that some perioperative parameters (i.e. nephrometry score, BMI, and tumor size) are associated with a different likelihood of trifecta success and are influenced by surgical approach. The ability to better predict optimal surgical outcomes will help to guide surgical decision-making.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this retrospective observational cohort study of prospectively gathered data, the trifecta outcome was defined as meeting all three criteria: negative surgical margin, ischemia time\u0026thinsp;\u0026lt;\u0026thinsp;25 minutes, and 30-day Clavien-Dindo classification\u0026thinsp;\u0026lt;\u0026thinsp;Grade III. A total of 753 patients with RCC who underwent RAPN from 2017\u0026ndash;2025 were identified in our institution's IRB-approved, prospective renal cancer database. Patients were stratified into cohorts based on SP and MP RAPN approach.\u003c/p\u003e \u003cp\u003eAnalysis was restricted to the complete-case set (N\u0026thinsp;=\u0026thinsp;596) with non-missing surgical margin status, ischemia time, and nephrometry score (SP\u0026thinsp;=\u0026thinsp;102, MP\u0026thinsp;=\u0026thinsp;494). Continuous variables were summarized with mean (SD) and median (IQR), categorical with counts (%) and compared between groups using Wilcoxon rank sum test, Pearson\u0026rsquo;s Chi-squared test, and Fisher\u0026rsquo;s exact test, as appropriate. Trifecta rates by surgical platform group were estimated with Wilson (score) 95% confidence intervals. Multiple logistic regression models were used to explore associations between a binary trifecta outcome and platform group, age, sex, BMI, nephrometry score (categorical: 4\u0026ndash;6, 7\u0026ndash;9, 10\u0026ndash;12), and tumor size. Alternatively, a stratified analysis was performed to see if the difference in rates of trifecta between MP and SP are different across the nephrometry score strata. Cochran\u0026ndash;Mantel\u0026ndash;Haenszel test was used to test the common odds ratio across the nephrometry score strata and the Breslow\u0026ndash;Day test was used to test the heterogeneity of the odds ratios across strata.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the complete-case cohort, there were several differences between SP and MP groups. The proportion of female patients was greater in the SP group compared to the MP group (43% vs 33%; p\u0026thinsp;=\u0026thinsp;0.046). Patients in the SP group had slightly lower median BMI (27.3 [24.2\u0026ndash;32.0] vs 29.4 [25.9\u0026ndash;33.6] kg/m\u0026sup2;; p\u0026thinsp;=\u0026thinsp;0.009), median nephrometry score (7 [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] vs 8 [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and median tumor size (2.50 [1.80\u0026ndash;3.50] vs 3.00 [2.20-4.00] cm; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age was similar between SP and MP cohorts (62 [53\u0026ndash;70] vs 62 [55\u0026ndash;70] years; p\u0026thinsp;=\u0026thinsp;0.38). See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics for SP and MP cohorts. Perioperative outcomes were similar across cohorts with comparable margin positivity rates in SP vs MP groups (2.9% vs 3.6%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.99) and median warm ischemia time (16 [0\u0026ndash;23] vs 17 [\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17 CR18 CR19 CR20\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] minutes, p\u0026thinsp;=\u0026thinsp;0.15). Postoperative complications were likewise rare and comparable between the SP and MP cohort during the hospital stay (p\u0026thinsp;=\u0026thinsp;0.81) and 30-day (p\u0026thinsp;=\u0026thinsp;0.24) periods. See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP, N\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP, N\u0026thinsp;=\u0026thinsp;494\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (53, 70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (55, 70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28, 82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23, 88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e332 (67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.5 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.1 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.3 (24.2, 32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.4 (25.9, 33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.6, 48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1, 60.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNephrometry Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (5, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (7, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4, 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4, 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNephrometry Score Category, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGreatest Tumor Dimensions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.77 (1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.36 (1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50 (1.80, 3.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00 (2.20, 4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30, 6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50, 13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e Wilcoxon rank sum test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e2\u003c/em\u003e Pearson\u0026rsquo;s Chi-squared test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative outcomes of the SP and MP cohorts. Trifecta rates were high in both groups: SP 0.76 (95% CI 0.67\u0026ndash;0.84) and MP 0.80 (95% CI 0.76\u0026ndash;0.83), with an absolute difference of 0.03 (95% CI\u0026thinsp;\u0026minus;\u0026thinsp;0.06 to 0.12; p\u0026thinsp;=\u0026thinsp;0.457). By nephrometry category, the overall distribution among all 596 patients was 28.4% (4\u0026ndash;6), 50.8% (7\u0026ndash;9), and 20.8% (10\u0026ndash;12). Within groups, row-wise percentages showed that SP patients who achieved the trifecta were more often in the lower-complexity stratum (4\u0026ndash;6: 59.0%, 7\u0026ndash;9: 30.8%, 10\u0026ndash;12: 10.3%), whereas MP patients who achieved the trifecta were most commonly in 7\u0026ndash;9 (54.8%) with 27.4% in 4\u0026ndash;6 and 17.8% in 10\u0026ndash;12. See \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSP, N\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMP, N\u0026thinsp;=\u0026thinsp;494\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMargin, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e476 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIschemia Time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (0, 23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (13, 21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0, 45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0, 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospital Stay Complications\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e447 (90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30-Day Complications\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IIIb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IVa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e470 (95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTrifecta Achievement\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e394 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003csup\u003e\u003cem\u003e3\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e Fisher\u0026rsquo;s exact test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2\u003c/em\u003e Wilcoxon rank sum test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e3\u003c/em\u003e Pearson\u0026rsquo;s chi square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number and percentage of patients within each nephrometry score category (4\u0026ndash;6, 7\u0026ndash;9, and 10\u0026ndash;12) stratified by surgical approach and by achievement of the trifecta. Percentages are calculated within each row so that each row sums to 100%. \u0026ldquo;Overall\u0026rdquo; rows represent totals within each surgical approach regardless of trifecta status, and the final row shows the combined distribution across all patients (N\u0026thinsp;=\u0026thinsp;596).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatform\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrifecta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u0026ndash;9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u0026ndash;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRow total\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e394 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e267 (54.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e494 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSum\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e169 (28.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e303 (50.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e124 (20.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e596 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Cochran\u0026ndash;Mantel\u0026ndash;Haenszel test controlling for nephrometry score strata estimated a common odds ratio of 1.6 (95% CI 0.93\u0026ndash;2.75; p\u0026thinsp;=\u0026thinsp;0.1144), indicating a nonsignificant overall tendency toward higher odds of trifecta in MP relative to SP after adjusting for nephrometry category. The Breslow\u0026ndash;Day test found no evidence of heterogeneity of the surgical platform effect (MP vs. SP) across nephrometry score strata (p\u0026thinsp;=\u0026thinsp;0.1995), indicating that the difference in trifecta rates between MP and SP does not change with increasing nephrometry score.\u003c/p\u003e \u003cp\u003eIn the multiple logistic regression, nephrometry score category was the only significant predictor of achieving the trifecta. Relative to 4\u0026ndash;6, 7\u0026ndash;9 had 63% lower odds (OR 0.37, 95% CI 0.19\u0026ndash;0.68; p\u0026thinsp;=\u0026thinsp;0.002) and 10\u0026ndash;12 had 81% lower odds (OR 0.19, 95% CI 0.09\u0026ndash;0.38; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting a monotonic decrease in odds with increasing nephrometry score. MP showed a non-significant increase in odds of trifecta relative to SP (OR 1.72, 95% CI 0.98\u0026ndash;2.97; p\u0026thinsp;=\u0026thinsp;0.052). Age, sex, BMI, and tumor size showed no independent associations (p\u0026thinsp;\u0026gt;\u0026thinsp;0.1). See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of multiple logistic regression modeling for factors predicted to impact trifecta achievement.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eModel with interaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eModel without interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatform\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.60 (0.13 to 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.72 (0.98 to 2.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.98 to 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0.98 to 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.58 to 1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94 (0.60 to 1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.97 to 1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0.97 to 1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNephrometry Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14 (0.03 to 0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37 (0.19 to 0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07 (0.01 to 0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.19 (0.09 to 0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGreatest Tumor Dimensions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.89 (0.78 to 1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89 (0.79 to 1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatform * Nephrometry Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP * 7\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.67 (0.87 to 19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMP * 10\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.31 (0.85 to 26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e1\u003c/em\u003e OR\u0026thinsp;=\u0026thinsp;Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdding the surgical platform \u0026times; nephrometry score category interaction did not significantly improve model fit (likelihood ratio test: ΔDeviance\u0026thinsp;=\u0026thinsp;3.84, 2 df, p\u0026thinsp;=\u0026thinsp;0.1465). Thus, there\u0026rsquo;s no strong evidence that the effect of surgical platform on trifecta differs by nephrometry category beyond the main-effects model.\u003c/p\u003e \u003cp\u003eThe results of logistic regression model without interaction term suggest that, after adjustment for the listed covariates, only nephrometry score was significantly associated with trifecta achievement. Relative to the reference 4\u0026ndash;6 nephrometry score category, patients with 7\u0026ndash;9 have 63% lower odds of trifecta achievement (OR\u0026thinsp;=\u0026thinsp;0.37, 95% CI 0.19\u0026ndash;0.68; p\u0026thinsp;=\u0026thinsp;0.002) and those with nephrometry scores of 10\u0026ndash;12 have 81% lower odds of trifecta achievement (OR\u0026thinsp;=\u0026thinsp;0.19, 95% CI 0.09\u0026ndash;0.38; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a monotonic decrease in odds with increasing nephrometry complexity category. MP had non-significantly higher odds of trifecta outcome compared to SP (OR\u0026thinsp;=\u0026thinsp;1.72, 95% CI 0.98\u0026ndash;2.97; p\u0026thinsp;=\u0026thinsp;0.052). Other covariates exhibited no evidence of independent association.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe SP surgical platform was introduced in 2018 to provide a more minimally invasive option for surgery. Recent meta-analyses have demonstrated that SP RAPN is associated with shorter length of stay and estimated blood loss with no difference in postoperative complications or margin status compared to MP, though the effect on ischemia time is less agreed upon [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The surgical trifecta has long been a metric for categorizing PN according to margin status, ischemia time, and complications and trifecta outcomes. As a high-volume institution, we are invested in implementing technologies that are safer, more efficient, and improve outcomes for our patients, which is why we chose to evaluate the performance of the SP robot compared to the MP gold standard at our institution for the surgical trifecta of RAPN.\u003c/p\u003e \u003cp\u003eThere are several key takeaways from this study. First, that trifecta achievement is high in both SP and MP RAPN (76 vs 80%). Second, on regression analysis, the odds of achieving the trifecta are not independently associated with surgical platform choice (p\u0026thinsp;=\u0026thinsp;0.052). Lastly, that increasing nephrometry score is the key negative predictor of trifecta achievement overall but that there is no difference in trifecta achievement in SP vs MP when adjusting for low, intermediate, and high nephrometry score tumors (OR 1.6, 95% CI 0.93\u0026ndash;2.75; p\u0026thinsp;=\u0026thinsp;0.1144).\u003c/p\u003e \u003cp\u003eTrifecta outcomes are commonly reported in the partial nephrectomy literature, though studies comparing trifecta achievement between the SP and MP platforms are sparse. Licari et al found an SP trifecta achievement of 57% compared to 63% in the MP cohort (p\u0026thinsp;=\u0026thinsp;0.8) in a small propensity matched study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Very recently, a large multi-institutional propensity matched study found SP vs MP trifecta achievement was 68.8% vs 64.7% (p\u0026thinsp;=\u0026thinsp;0.051) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our institutional data demonstrates similar or better rates compared to the literature. We hypothesize that the improved trifecta outcomes in both SP and MP may be associated with the high volume of nephron-sparing surgery performed at our institution as well as potentially higher rates of off-clamp partial nephrectomy, which results in zero ischemia time and heavily contributes to trifecta achievement. Although SP is relatively new and being more widely adopted, the literature and our data agree that the trifecta can be achieved with similar rates to MP. The results of this study are also notable because they help clarify patient selection for partial nephrectomy. Although the odds of achieving the surgical trifecta decrease as tumor complexity increases, there is not a differential impact in SP compared to MP, and surgeons can feel confident electing to utilize a more minimally invasive SP approach without sacrificing perioperative outcomes.\u003c/p\u003e \u003cp\u003eWith these findings in mind, it is still important to note that there is a learning curve for the SP robot. With a smaller workspace volume inherent to SP and technical differences compared to MP that stem from having multiple instruments in much closer proximity, the SP robot can present challenges for new adopters. As a result, surgeons should bear in mind that the trifecta outcomes we demonstrate in this study, as well as other studies reporting high trifecta achievement with SP, are a product of experience with this platform. Surgeons with less experience using SP should still carefully consider patient selection when adopting SP.\u003c/p\u003e \u003cp\u003eThe role of the R.E.N.A.L nephrometry score [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] in the achievement of trifecta outcomes is also well-founded in the literature, which is why we included it in our analysis. Zargar et al recently found on multivariate analysis of RAPN and laparoscopic partial nephrectomy (LPN) that nephrometry score 10\u0026ndash;12 and tumor size were negative predictors of trifecta achievement. Interestingly, this study also found RAPN to be predictive of achieving the trifecta relative to LPN, though trifecta achievement in the LPN cohort was lower than is typically seen in the literature (77% vs 33%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Bindayi et al demonstrated in a large group of open partial nephrectomy (OPN), LPN, and RPN patients that tumor size in addition to nephrometry score (OR 1.26, p\u0026thinsp;=\u0026thinsp;0.007) were predictors of the trifecta on multivariate analysis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Likewise, even more recent analysis of the R.E.N.A.L, PADUA, and SPARE scores found each to be predictive of trifecta achievement in SP RAPN, with the R.E.N.A.L score specifically predictive of the intermediate risk nephrometry score group (OR 0.462, 95% CI 0.233\u0026ndash;0.899; p\u0026thinsp;=\u0026thinsp;0.025) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Studies examining trifecta outcomes in both SP and MP RAPN have pointed to tumor complexity as a key component of these outcomes, but these studies lack stratification of this effect according to these surgical platforms. To our knowledge, there is no study that stratifies this by SP and MP surgical platform, which is why we included this in our analysis. Our findings demonstrate similar results to the literature in that trifecta outcomes in RAPN are closely related to nephrometry score with the novel addition that there is no difference between the SP and MP platforms when adjusting for differences in nephrometry score.\u003c/p\u003e \u003cp\u003eWe acknowledge there are limitations to this study. First, although the data in this study was collected prospectively, the retrospective nature of the analysis and lack of randomization to surgical platform could introduce selection bias. Surgical platform choice was instead based on surgeon preference, which could also be a potential source of selection bias or confounding by indication. Second, our institution performs a high volume of RAPN and SP surgery, which could play a role in the comparable outcomes of our SP and MP cases. Likewise, surgeon experience could play a role in trifecta achievement and would not be quantified in this analysis. These findings should be validated with a multi-institutional cohort to capture a larger variety of SP experience and could consider incorporating surrogate measures for surgeon experience, both in general and with the SP robot specifically. Lastly, in our multivariate analysis we included both tumor size as well as the R.E.N.A.L nephrometry score, which already takes size into account. This could introduce a masking of the effect of either variable in the analysis, although similar methodology exists in the literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Future study should consider incorporating each element of the nephrometry score as its own variable in the multivariate analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● BMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● GFR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlomerular filtration rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● IQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● LPN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLaparoscopic partial nephrectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● MP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMulti-port\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● OPN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOpen partial nephrectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● OR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● PADUA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePreoperative Aspects and Dimensions Used for an Anatomical evaluation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● PN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePartial nephrectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● R.E.N.A.L\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRadius, Exophytic/endophytic, Nearness, Anterior/Posterior, Location\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● RAPN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRobot-assisted partial nephrectomy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● RCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRenal cell carcinoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● SD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● SP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSingle-port\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e● SPARE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSimplified PADUA Renal\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e Authors Jacob O’Hara, Pranesh Rajendran, Ji Whae Choi, Laurence Hou, Simon Gelman, Aisha Kourouma, Mubashir S. Billah, and Nitin Yerram declare they have no financial interests. Ravi Munver serves as a consultant for PROCEPT BioRobotics and has received an educational grant from Boston Scientific. Mutahar Ahmed serves as a consultant for Intuitive Surgical, BioTissue, Ethicon, Lexion Medical, and Vascular Technology Inc. Michael Stifelman serves as a consultant for Intuitive Surgical and Vascular Technology Inc.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by JO, PR, JWC, and AK. Statistical analysis was performed by SG. The first draft of the manuscript was written by JO, PR, and JWC and all authors commented on previous versions of the manuscript. Critical revisions of the manuscript were made by JO, MB, MA, MS, and NY. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u003c/strong\u003e This study received ethics approval with its IRB approval on 5/24/2017 (Pro2016-0680).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e Informed consent was obtained from all individual participants included in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u003c/strong\u003e Consent to publish was obtained from all individuals included in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLarcher A, Campi R, Bex A et al (2025) Epidemiology of Renal Cancer: Incidence, Mortality, Survival, Genetic Predisposition, and Risk Factors. Eur Urol 88:341\u0026ndash;358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eururo.2025.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2025.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCancer of the Kidney and Renal Pelvis - Cancer Stat Facts (2026) SEER n.d. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://seer.cancer.gov/statfacts/html/kidrp.html\u003c/span\u003e\u003cspan address=\"https://seer.cancer.gov/statfacts/html/kidrp.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePecoraro A, Palumbo C, Knipper S et al (2021) Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database-based Study. Eur Urol Focus 7:818\u0026ndash;826. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.euf.2020.02.011\u003c/span\u003e\u003cspan address=\"10.1016/j.euf.2020.02.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLundstam S, Almdalal T, Rosenblad AK et al (2025) Is Partial Nephrectomy A Primary Option for Patients with T1b Renal Cell Carcinoma-A National Population-Based Study. Urol Res Pract 50:322\u0026ndash;327. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5152/tud.2025.24081\u003c/span\u003e\u003cspan address=\"10.5152/tud.2025.24081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBex A, Ghanem YA, Albiges L et al (2025) European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update. Eur Urol 87:683\u0026ndash;696. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eururo.2025.02.020\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2025.02.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenal Mass and Localized Renal Cancer: Evaluation, Management, and Follow Up (2021) - American Urological Association n.d. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up#x15411\u003c/span\u003e\u003cspan address=\"https://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up#x15411\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed February 11, 2026)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEastham JA, Scardino PT, Kattan MW (2008) Predicting an optimal outcome after radical prostatectomy: the trifecta nomogram. J Urol 179:2207\u0026ndash;2210 discussion 2210\u0026ndash;2211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.juro.2008.01.106\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2008.01.106\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShikanov SA, Zorn KC, Zagaja GP et al (2009) Trifecta outcomes after robotic-assisted laparoscopic prostatectomy. Urology 74:619\u0026ndash;623. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.urology.2009.02.082\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2009.02.082\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung AJ, Cai J, Simmons MN et al (2013) Trifecta in partial nephrectomy. J Urol 189:36\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.juro.2012.09.042\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2012.09.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai N, Qi M, Shan D et al (2022) Trifecta achievement in patients undergoing partial nephrectomy: a systematic review and meta-analysis of predictive factors. Int Braz J Urol 48:625\u0026ndash;636. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/S1677-5538.IBJU.2021.0095\u003c/span\u003e\u003cspan address=\"10.1590/S1677-5538.IBJU.2021.0095\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmidele OO, Davoudzadeh N, Palese M (2018) Trifecta Outcomes to Assess Learning Curve of Robotic Partial Nephrectomy. JSLS. ;22:e2017.00064. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4293/JSLS.2017.00064\u003c/span\u003e\u003cspan address=\"10.4293/JSLS.2017.00064\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZargar H, Allaf ME, Bhayani S et al (2015) Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int 116:407\u0026ndash;414. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/bju.12933\u003c/span\u003e\u003cspan address=\"10.1111/bju.12933\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalpin GG, Ryan FR, McHugh FT et al (2023) Comparing the outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a network meta-analysis. BJU Int 132:353\u0026ndash;364. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/bju.16093\u003c/span\u003e\u003cspan address=\"10.1111/bju.16093\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerry JM, Hill H, Vetter JM et al Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023:1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-023-01637-4\u003c/span\u003e\u003cspan address=\"10.1007/s11701-023-01637-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen TT, Ngo XT, Duong NX et al (2024) Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis. J Endourol 38:253\u0026ndash;261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/end.2023.0505\u003c/span\u003e\u003cspan address=\"10.1089/end.2023.0505\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu A, Lv Z, Chen G et al (2024) Comparison of single-port versus multi-port robotic assisted partial nephrectomy: a systematic review and meta-analysis of perioperative and oncological outcomes. J Robot Surg 18:321. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-024-02066-7\u003c/span\u003e\u003cspan address=\"10.1007/s11701-024-02066-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBang S, Yu J, Bae H et al (2024) Single-Port Versus Multi-Port Robotic Retroperitoneal Partial Nephrectomy: A Propensity Score-Matched Comparison. J Endourol 38:1353\u0026ndash;1358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/end.2024.0493\u003c/span\u003e\u003cspan address=\"10.1089/end.2024.0493\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarletti F, Valenzi FM, Tamborino F et al (2025) Predicting surgical outcomes in single-port robot-assisted partial nephrectomy: external validation and comparative analysis of PADUA, RENAL, and SPARE scores. World J Urol 43:707. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-025-06081-7\u003c/span\u003e\u003cspan address=\"10.1007/s00345-025-06081-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLicari LC, Bologna E, Franco A et al (2024) Single-port vs multi-port robot-assisted partial nephrectomy: A single center propensity score-matched analysis. Eur J Surg Oncol 50:108011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejso.2024.108011\u003c/span\u003e\u003cspan address=\"10.1016/j.ejso.2024.108011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoputro NA, Saxena S, Bamby J et al Single-port Robotic Retroperitoneal Partial Nephrectomy via Low Anterior Access: A Propensity-matched Comparative Analysis to Standard Transperitoneal Multiport Robotic Surgery from the Single Port Advanced Research Consortium (SPARC). Eur Urol Focus 2025:S2405-4569(25)00361-X. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.euf.2025.12.008\u003c/span\u003e\u003cspan address=\"10.1016/j.euf.2025.12.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844\u0026ndash;853. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.juro.2009.05.035\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2009.05.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBindayi A, Autorino R, Capitanio U et al (2020) Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group. Eur Urol Focus 6:982\u0026ndash;990. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.euf.2019.02.010\u003c/span\u003e\u003cspan address=\"10.1016/j.euf.2019.02.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Single-port, multi-port, partial nephrectomy, trifecta, robotic surgery","lastPublishedDoi":"10.21203/rs.3.rs-9153976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9153976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eEvidence from the literature suggests that patients with more complex tumors are less likely to achieve the surgical trifecta\u0026mdash;defined as negative margins, ischemia time under 25 minutes, and the absence of Clavien-Dindo grade III or higher postoperative complications. The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOur institution\u0026rsquo;s IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were estimated using Wilson score 95% confidence intervals. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe SP RAPN (N\u0026thinsp;=\u0026thinsp;102) cohort included fewer male patients and had lower BMI, nephrometry scores, and tumor sizes compared to the MP cohort (N\u0026thinsp;=\u0026thinsp;494). Trifecta achievement did not differ significantly between the SP (76%) and MP (80%) groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.46). The odds of trifecta achievement were not significantly influenced by surgical platform choice (p\u0026thinsp;=\u0026thinsp;0.052). Among the factors we analyzed, only nephrometry score was significantly associated with trifecta achievement, while surgical approach showed no significant association.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWe conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity.\u003c/p\u003e","manuscriptTitle":"Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-31 21:04:38","doi":"10.21203/rs.3.rs-9153976/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T17:40:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T01:26:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T13:57:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333940948803269033807346607194880006070","date":"2026-03-30T12:47:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234029962866223600508606934025315259157","date":"2026-03-30T11:27:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-30T07:44:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-24T14:51:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T01:14:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2026-03-18T03:17:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a8a15641-b038-4bf4-a096-a6c1d78fc85d","owner":[],"postedDate":"March 31st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T11:25:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-31 21:04:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9153976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9153976","identity":"rs-9153976","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}