Should A Drain Be Routinely Required After Transperitoneal Robotic Partial Nephrectomy

Introduction Closed drains have traditionally been placed after partial nephrectomy due to risks of bleeding and urine leak. We sought to study the safety of a non-routine drain (NRD) protocol following transperitoneal robotic partial nephrectomy (RPN). Patients and Methods From a multi-institutional database, we have analyzed the data of 904 patients who underwent RPN. 546 (60.40%) patients underwent RPN by a surgeon who had a routine drain (RD) protocol. 358 (39.60%) patients underwent RPN by a surgeon who had a NRD protocol. Perioperative outcomes, length of stay (LOS) and readmission rates were compared between the two groups. Baseline characteristics, perioperative and postoperative outcomes were compared using Mann Whitney U test, Chi-square test and Fishers exact tests. Results Patients in the NRD protocol were more likely to have higher BMI (30.10 kg/m2 vs. 28.07 kg/m2; p <0.001), higher tumor size (3.0 cm vs. 2.5cm; p=0.001), and higher renal score (8 vs. 7; p<0.001). Rate of transfusion (0.00% NRD vs. 0.56% RD; p = 0.157) and overall complication (7.33% NRD vs. 7.82% RD; p=0.782) were comparable. Median hospital stay is 1 day for both groups. Readmission rate was also similar (0.55% NRD vs. 1.40% RD; p=0.279). In a multivariable analysis, NRD protocol was associated with shorter length of hospital stay (Incident Rate Ratio [IRR] - 0.72, p<0.001). Conclusion A NRD protocol for robotic partial nephrectomy yielded a decreased length of stay and similar perioperative outcomes. Placement of surgical drains should be based on individual circumstances, and not required on a routine basis.