Feasibility of a new L43K ultrasound probe attachment for intraoperative laparoscopic ultrasonography in robot-assisted partial nephrectomy

Background We assessed the feasibility of a new probe attachment (PA) developed to improve the ease of holding the drop-in-type L43K ultrasound probe during robot-assisted partial nephrectomy. Materials and methods We retrospectively analyzed the outcomes of 58 patients after robot-assisted partial nephrectomy using the conventional grip and 13 patients after surgery using the PA between September 2019 and February 2021. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. The usability of the PA was evaluated regarding (1) total procedure time for intraoperative laparoscopic ultrasound; (2) proportion rate of intraoperative laparoscopic ultrasound in console time; (3) total number of probe fin grips; (4) total number of grip failures; (5) intraoperative laparoscopic ultrasound procedure time per grip; and (6) rate of successful gripping. Results After matching, 12 patients were allocated to each group, and the tumor site was significantly different between the groups. Usability was significantly better in the PA group: (1) conventional versus PA: 6.8 versus 7.6, p = 0.53; (2) 5.6% versus 6.1%, p = 0.61; (3) 8 versus 10, p = 0.32; (4) 3 versus 0, p = 0.014; and (5) 1.5% versus 0.7%, p = 0.021; (6) 66% versus 100%, p = 0.002. In patients with complex renal tumors, completely endophytic tumors, and renal hilum tumors, nearly identical improvements in usability were observed: (1) 9.8 versus 7.8 min, p = 0.21; (2) 9.9% versus 4.7%, p = 0.001; (3) 7 versus 6, p = 0.025; (4) 3 versus 0, p = 0.048, (5) 2.9 versus 1.6 min, p = 0.89, and (6) 60% versus 100%, p = 0.003. Conclusions Our proposed L43K PA can enhance the usability of the probe for intraoperative laparoscopic ultrasonography during robot-assisted partial nephrectomy and increase the accuracy of ultrasonography for complex renal tumors.