Dual Bipolar Strategy and Postoperative Drain Output in Robot-assisted Radical Nephrectomy

Background/Aim: This study aimed to investigate the clinical utility of the dual bipolar method (DBM) in robot-assisted radical nephrectomy (RARN), with a particular focus on postoperative drain output. Patients and Methods: This prospective observational cohort study included 50 consecutive patients who underwent RARN. Patients were classified into a DBM group (n=12) and a non-DBM group (n=38) according to DBM use. The primary outcome was postoperative drain output. Secondary outcomes included operative time, console time, estimated blood loss, length of hospital stay, time to oral intake, time to first bowel movement, and postoperative complication rate. Results: Median drain output on postoperative day (POD) 1 was significantly lower in the DBM group compared to the non-DBM group (63.5 vs. 130.0 ml, p=0.032). Cumulative drain output from POD1 to POD5 was also significantly lower in the DBM group (85.0 vs. 245.0 ml, p=0.047). In contrast, operative time (p=0.002) and console time (p=0.032) were significantly longer in the DBM group. No significant differences were observed in other perioperative outcomes. Multivariable analysis showed that DBM use was the only factor significantly associated with cumulative drain output from POD1 to POD5 (β=151.95, 95% confidence interval=14.17-289.73, p=0.031). Conclusion: DBM in RARN was associated with significantly reduced postoperative drain output. Although console time was significantly longer in the DBM group, no specific adverse events attributable to DBM were observed. DBM may therefore be a useful technique in RARN, particularly for reducing postoperative drainage.