{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:23:41Z","timestamp":1791933821790,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study was performed to investigate the preoperative factors associated with difficulty achieving trifecta in robot\u2010assisted partial nephrectomy for clinical T1b renal cell carcinoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among 187 patients who underwent robot\u2010assisted partial nephrectomy at our hospital from March 2012 to February 2022, we retrospectively examined 30 patients with unilateral single clinical T1b renal cell carcinoma with at least 6\u00a0months of postoperative follow\u2010up, excluding patients with hereditary disease. The following factors were examined in detail: patient\u2010related factors, perioperative factors, surgical techniques, tumor factors, and R.E.N.A.L. nephrometry scores. We examined the preoperative factors associated with difficulty achieving trifecta. A positive surgical margin was pathologically defined as the presence of tumor cells at the margin of the resected specimen or visually defined as intraoperative tumor incision or pseudocapsular damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 30 patients in this study, 12 achieved trifecta and 18 did not. The reasons for not achieving trifecta were a warm ischemia time of &gt;25\u2009min (66.7%), positive surgical margin (23.3%), and Clavien\u2013Dindo grade\u2009\u22653 complications (13.3%) (with overlapping factors). No patients had a pathologically positive surgical margin. Visually positive surgical margins were confirmed by the surgical records and surgical videos. Achieving trifecta was challenging in the multivariate analysis when the \u201cL\u201d component of the R.E.N.A.L. nephrometry score was \u22652 points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A preoperative \u201cL\u201d component of \u22652 points in the R.E.N.A.L. nephrometry score was associated with difficulty achieving trifecta.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ases.13182","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T08:39:35Z","timestamp":1679992775000},"page":"441-446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of trifecta outcomes in a single center with robot\u2010assisted partial nephrectomy for T1b renal tumors"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7841-1104","authenticated-orcid":false,"given":"Kimihiko","family":"Masui","sequence":"first","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  54 Shogoin\u2010kawahara\u2010cho, Sakyo\u2010ku Kyoto 606\u20108507 Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-452X","authenticated-orcid":false,"given":"Takashi","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  54 Shogoin\u2010kawahara\u2010cho, Sakyo\u2010ku Kyoto 606\u20108507 Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine  54 Shogoin\u2010kawahara\u2010cho, Sakyo\u2010ku Kyoto 606\u20108507 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