Editorial Comment on: Impact of the Mayo Adhesive Probability Score on the Complexity of Robot-Assisted Partial Nephrectomy by Ishiyama et al.

The authors validate the impact of the Mayo Adhesive Probability (MAP) score ¹ on operative time in their robot-assisted partial nephrectomy (RAPN) experience (n = 311). ² They find a significant association between MAP score and length of “dissection phase” >90 minutes during RAPN (odds ratio 6.2, p < 0.01 for MAP ≥3). Although their definition of “dissection phase,” which spans from robot docking to hilar clamping, is relatively crude, the observed increase with higher MAP score is illustrative. One would expect the correlation to strengthen if the “dissection phase” were further restricted to hilar dissection and tumor exposure.

As adherent (“sticky”) perinephric fat is a known technical challenge during RAPN, the study findings are not unexpected. However, demonstrating a clear correlation between an objective measure of technical difficulty—MAP score—and a commonly used measure of surgical quality—operative time—is important to our field. Such a relationship supports the use of the MAP score in assisting preoperative prediction of operative complexity in conjunction with other known tumor complexity models such as the R.E.N.A.L. nephrometry score. ³ Furthermore, in this increasingly scrutinous healthcare environment, we must define and establish our own objective metrics for patient and surgical complexity to ensure fair comparison of outcomes across institutions. ^4,5