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Journal of Endourology Jul 2018To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN).
OBJECTIVES
To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN).
MATERIALS AND METHODS
A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion.
RESULTS
Seven retrospective case-control studies were identified and included in the analysis, with a total number of 1379 patients (866 for transperitoneal group; 513 for retroperitoneal group). In the retroperitoneal group, tumors were slightly larger [weighted mean difference (WMD): 0.29 cm; 95% confidence interval (CI): 0.04-0.54; p = 0.02], and more frequently located posterior/lateral (odds ratio: 0.61; 95% CI: 0.41-0.90; p = 0.01). In two of the studies only posterior tumors had been included. Both operating time (WMD 20.17 min; 95% CI 6.46-33.88; p = 0.004) and estimated blood loss (WMD 54.57 mL; 95% CI 6.73-102.4; p = 0.03) were significantly lower in the retroperitoneal group. In addition, length of stay was significantly shorter in the retroperitoneal group (WMD 0.46 days; CI 95% 0.15-0.76; p = 0.003). No differences were found regarding overall (p = 0.67) and major (p = 0.82) postoperative complications, warm ischemia time (p = 0.96), and positive surgical margins (p = 0.95).
CONCLUSIONS
Retroperitoneal RAPN can offer in select patients similar outcomes to those of the most common transperitoneal RAPN. Furthermore, it may be particularly advantageous for posterior upper pole and perihilar tumors and associated with reduction in operative time and hospital stay. Robotic surgeons should be ideally familiar with both approaches to adapt their surgical strategy to confront renal neoplasms from a position of technical advantage and ultimately optimize outcomes.
Topics: Blood Loss, Surgical; Case-Control Studies; Humans; Kidney Neoplasms; Length of Stay; Margins of Excision; Nephrectomy; Odds Ratio; Operative Time; Postoperative Complications; Retroperitoneal Space; Retrospective Studies; Robotic Surgical Procedures; Warm Ischemia
PubMed: 29695171
DOI: 10.1089/end.2018.0211 -
Minerva Urology and Nephrology Apr 2022The aim of this paper was to evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port... (Review)
Review
BACKGROUND
The aim of this paper was to evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port (SP) platform.
METHODS
A retrospective review was conducted from December 2018 to December 2019 of 14 consecutive patients with localized renal cancer who underwent SP robot-assisted partial nephrectomy at a single institution. The procedures were performed by 2 experienced robotic surgeons, reproducing the steps of the standard multiport robotic approach to partial nephrectomy. A transperitoneal approach was utilized with a 2.5 cm para-rectus incision with one assistant 12 mm laparoscopic port.
RESULTS
No conversions to open or laparoscopic surgery occurred and no additional laparoscopic assistant ports were required. The median total operative time was 202 (162-231) minutes and the median total room time was 258 (215-295) minutes. The warm ischemia time averaged 20±8 minutes. 2 patients required angioembolization due to postoperative acute bleeding (Clavien-Dindo Grade 3a complication). Trifecta outcome (<25 min warm ischemia, no perioperative complications and negative margins) was achieved in 79% of patients. In one case, a positive margin was present. The median length of stay was of 1 day (Interquartile Range 1-2) with a median pain score on post-operative day 1 of 3.5 (Interquartile Range 2.4-5); 1/14 (7%) patient needed narcotic use at one week from discharge. At a median follow up of 5.0 (4.0-8.0) months, no patients have had evidence of disease recurrence.
CONCLUSIONS
In this initial cohort, considering the introduction of a new technology, we observed satisfactory outcomes for several key perioperative variables including operative time, warm ischemia time, surgical margins, hospital stay, pain requirements in patients undergoing RAPN with the SP platform. For experienced robotic surgeons, RAPN with the SP platform is a safe and feasible approach for single site partial nephrectomy.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Retrospective Studies; Robotic Surgical Procedures
PubMed: 33769009
DOI: 10.23736/S2724-6051.21.03919-9 -
European Review For Medical and... May 2024The primary surgical techniques used to treat localized renal tumors are laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Obese... (Comparative Study)
Comparative Study
OBJECTIVE
The primary surgical techniques used to treat localized renal tumors are laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Obese patients have more intra-abdominal fat accumulation, which may make the localization and operation in minimally invasive surgery more complicated. Currently, limited research has been conducted on which method is more suitable for performing a partial nephrectomy on obese individuals. The aim of our investigation was to analyze and compare the perioperative results associated with both approaches to offer valuable information about the selection of LPN or RAPN as an optimal choice when performing a partial nephrectomy in obese patients.
PATIENTS AND METHODS
We retrospectively collected clinical data from 78 cases of obese individuals [Body mass index (BMI) > 28] who underwent RAPN, as well as 50 cases of obese individuals (BMI > 28) who underwent LPN. The analysis covered various aspects, including initial patient characteristics, glomerular filtration rate (GFR), warm ischemia time (WIT), operation time, volume of blood loss during the surgical procedure, time taken to recover bowel function, positive surgical margin rate, incidence of postoperative complications, and postoperative hospital stay.
RESULTS
We observed that RAPNs exhibited shorter warm ischemia time and reduced intraoperative blood loss in obese patients, along with decreased postoperative duration of abdominal drainage and hospitalization periods compared to LPNs.
CONCLUSIONS
In obese patients, RAPN demonstrates advantages over LPN in minimizing intraoperative blood loss, WIT, and facilitating postoperative recovery. These findings may serve as valuable evidence when considering the choice between LPN or RAPN for partial nephrectomy in obese individuals.
Topics: Humans; Nephrectomy; Laparoscopy; Obesity; Robotic Surgical Procedures; Female; Middle Aged; Male; Retrospective Studies; Kidney Neoplasms; Treatment Outcome; Aged; Postoperative Complications; Adult; Length of Stay; Operative Time
PubMed: 38856133
DOI: 10.26355/eurrev_202405_36294 -
Asian Journal of Surgery Jun 2023To compare the perioperative outcomes of patients with complex renal tumors treated with open versus robot-assisted partial nephrectomy.
OBJECTIVE
To compare the perioperative outcomes of patients with complex renal tumors treated with open versus robot-assisted partial nephrectomy.
METHODS
This retrospective study included 273 patients diagnosed with localized renal tumors at our institution between January 2007 and October 2020. Patients with moderate to high complexity tumors based on the RENAL nephrometry score were included. Perioperative outcomes were compared between open and robot-assisted partial nephrectomy patients. Remnant renal function was defined as the estimated glomerular filtration rate at 12 months after surgery.
RESULTS
Open and robot-assisted partial nephrectomy were performed in 43 and 77 patients, respectively. There was no significant difference in overall, cancer-specific, recurrence-free, and metastasis-free survival between the two groups. Remnant renal function was significantly better preserved in the open group, and body mass index was identified as an independent predictive factor (odds ratio 3.05, P = 0.017). Ischemia or type of surgery were not related to remnant renal function. The trifecta achievement rate was 51.2% in the open group and 71.4% in the robot-assisted group (P = 0.031), and the incidence of complications was significantly higher in the open partial nephrectomy group (P = 0.0030). Multivariate analysis revealed that open partial nephrectomy was an independent predictive factor for the incidence of complications (odds ratio 3.92, P = 0.0020).
CONCLUSION
Robot-assisted partial nephrectomy can provide good and acceptable oncological and functional outcomes with fewer complications in patients with more complex renal tumors. Further research is needed to establish appropriate treatment strategies and guidelines in current clinical practice.
Topics: Humans; Robotics; Retrospective Studies; Treatment Outcome; Kidney Neoplasms; Robotic Surgical Procedures; Nephrectomy
PubMed: 36283875
DOI: 10.1016/j.asjsur.2022.09.155 -
Archivio Italiano Di Urologia,... Jun 2017To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours.
MATERIALS AND METHODS
Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes.
RESULTS
There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin.
CONCLUSIONS
RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.
Topics: Female; Humans; Kidney Neoplasms; Laparoscopy; Male; Middle Aged; Nephrectomy; Retrospective Studies; Robotic Surgical Procedures
PubMed: 28679176
DOI: 10.4081/aiua.2017.2.93 -
International Journal of Surgery... Dec 2016Cryoablation (CA) has been broadly used mostly in the treatment of small renal masses (SRMs). The present review aims to define the current role of CA in the treatment... (Review)
Review
INTRODUCTION
Cryoablation (CA) has been broadly used mostly in the treatment of small renal masses (SRMs). The present review aims to define the current role of CA in the treatment of SRMs by assessing clinical indications and outcomes.
METHOD
A comprehensive review on patient selection, procedural details, perioperative complications, and short/long-term oncological and functional outcomes was conducted. For each section, a take-home message was formulated with level of evidence (LoE) according to Cochrane collaboration.
RESULTS
Age and comorbidity drive the choice of ablation in SRMs, although hospital setting also influences the decision. Technically in adequate CA or first post-CA control occurs in 3-5% of laparoscopic cryoablation (LCA) or percutaneous cryoablation (PCA) series. Meta-analysis does not evidence differences in the rate of residual tumor per person-year between the approaches (0.033 LCA vs. 0.046 PCA, p = 0.25). Perioperative complications (8-25%) are erratically reported. LCA has significantly lower likelihood of complications than minimally invasive partial nephrectomy (MIPN). Systematic reviews indicate 30-month local tumor progression rate of 8.5% for LCA in renal cell carcinoma but low metastatic progression (1-4.4%). Few LCA long-term follow-up series (mean/media 48-98 months) report recurrence-free survival (RFS) and cancer-specific survival (CSS) ranges of 80-100%. For PCA, Kaplan-Meier local disease-free survival (DFS) of 95.6% at 3-5 years [32] and 5-year overall survival and local RFS of 86.3% were reported. The decrease in renal function after CA is minimal, and the only risk factor associated is the basal estimated glomerular filtration rate (eGFR).
CONCLUSION
LoE 3a/b confirms lower CA perioperative complication rate and higher local progression rate than those for MIPN. CA preserves postoperative renal functional, without any evidence of differences in mid-/long-term follow-up compared to nephron sparing surgery.
Topics: Age Factors; Aged; Carcinoma, Renal Cell; Catheter Ablation; Cryosurgery; Disease Progression; Disease-Free Survival; Female; Humans; Kidney; Kidney Neoplasms; Laparoscopy; Male; Middle Aged; Nephrectomy; Patient Selection; Risk Factors; Treatment Outcome
PubMed: 27500963
DOI: 10.1016/j.ijsu.2016.06.049 -
Journal of Pediatric Surgery Nov 2019To compare and contrast the use of partial nephrectomy (PN) and radical nephrectomy (RN) in pediatric malignant renal tumors using a nationally representative database. (Comparative Study)
Comparative Study
OBJECTIVES
To compare and contrast the use of partial nephrectomy (PN) and radical nephrectomy (RN) in pediatric malignant renal tumors using a nationally representative database.
METHODS
The 2010-2014 Nationwide Readmissions Database (NRD) was used to obtain PN and RN select postoperative data. ICD-9-CM codes were used to identify children (<10 years), adolescents (10-19 years) and young adults (20-30 years) diagnosed with malignant renal tumors who were treated with a PN or RN. The presence of a 30-day readmission, occurrence of postoperative complications, cost, and length of stay (LOS) were studied and weighted logistic regression models were fit to test for associations.
RESULTS
There were 4330 weighted encounters (1289 PNs, 3041 RNs) that met inclusion criteria: 50.8% were children, 7.2% were adolescents, and 42% were young adults. Young adults had the highest rates of PN, whereas children had the highest rates of RN (p < 0.0001). Overall, no evidence was found to suggest a difference in odds between surgical modality and the presence of a 30-day readmission or postoperative complication. While PN was on average $9000 cheaper compared to RN overall, its cost was similar to that of RN for children. Similarly, PN patients had a shorter overall LOS compared to RN patients, but their LOS was similar to that of children who underwent RN.
CONCLUSION
There was no evidence of a difference in odds between RN and PN in terms of postoperative readmissions or in-hospital complication rates. Additionally, we observed descriptive differences in both cost and LOS between the surgical modalities across age groups.
TYPE OF STUDY
Retrospective comparative study (administrative database analysis).
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Child; Databases, Factual; Female; Humans; Kidney Neoplasms; Length of Stay; Male; Nephrectomy; Patient Readmission; Postoperative Complications; Retrospective Studies; United States; Young Adult
PubMed: 31178166
DOI: 10.1016/j.jpedsurg.2019.05.018 -
World Journal of Surgical Oncology Aug 2016Robot-assisted partial nephrectomy (RAPN) has been widely used worldwide, to determine whether RAPN is a safe and effective alternative to open partial nephrectomy (OPN)... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Robot-assisted partial nephrectomy (RAPN) has been widely used worldwide, to determine whether RAPN is a safe and effective alternative to open partial nephrectomy (OPN) via the comparison of RANP and OPN.
METHODS
A comprehensive literature search was performed within the databases including PubMed, Cochrane Library, and Embase updated on 30 September 2015. Summary data with their corresponding 95 % confidence intervals (CIs) were calculated using a random effects or fixed effects model. Heterogeneity and publication bias were also evaluated.
RESULTS
A total of 16 comparative studies including 3024 cases were used for this meta-analysis. There are no significant differences in the demographic characteristic between the two groups, but the age was lower and the tumor size was smaller for the RAPN group. RAPN had a longer operative time and warm ischemia time but which showed less estimated blood loss, hospital stay, and perioperative complications. No differences existed in the margin status, the change of glomerular filtration rate, transfusion rate, and conversion rate between the two groups. There was no significant publication bias.
CONCLUSIONS
RAPN offered a lower rate of perioperative complications, less estimated blood loss, and shorter length of hospital stay than OPN, suggesting that RAPN can be an effective alternative to OPN. Well-designed prospective randomized controlled trials will be helpful in validating our findings.
Topics: Blood Component Transfusion; Blood Loss, Surgical; Conversion to Open Surgery; Glomerular Filtration Rate; Humans; Kidney Neoplasms; Length of Stay; Margins of Excision; Nephrectomy; Operative Time; Robotic Surgical Procedures; Treatment Outcome; Warm Ischemia
PubMed: 27549155
DOI: 10.1186/s12957-016-0971-9 -
Cancer Control : Journal of the Moffitt... Jul 2015Minimally invasive surgical techniques have revolutionized the surgical management of kidney cancer. Current evidence suggests that the surgical developments gained by... (Review)
Review
BACKGROUND
Minimally invasive surgical techniques have revolutionized the surgical management of kidney cancer. Current evidence suggests that the surgical developments gained by traditional laparoscopy have been advanced by the robotic platform, particularly as it has been applied to techniques for nephron preservation.
METHODS
The medical literature from peer-reviewed journals was reviewed to evaluate the feasibility and efficacy of robotic-assisted surgery in the management of renal cell carcinoma. Particular attention was paid to studies comparing robotic-assisted surgery with more traditional surgical techniques. In this review, we have highlighted the evolution of robotic assistance for renal surgery as it pertains to renal oncology. The differing approaches to standard surgeries are discussed as well as current trends to improve perioperative outcomes.In addition, we have reviewed the application of robotic assistance to more complex cases and highlight technological advancements that have pushed the boundaries of surgical care.
RESULTS
Robotic-assisted renal surgery is effective for appropriately selected patients. Robotic-assisted radical nephrectomy provides equivalent outcomes to traditional open and laparoscopic approaches, albeit with added financial burden. Robotic-assisted partial nephrectomy - through either transperitoneal or retroperitoneal access - can provide superior outcomes to laparoscopic approaches due to several technical advantages,including improved instrument articulation.
CONCLUSIONS
Robotic assistance has transformed the delivery of surgical care to the patient with renal cell carcinoma. For renal surgery, morbidity and patient satisfaction are potentially improved when using robotic platforms compared with open and traditional laparoscopic approaches without compromising oncological control, and this is particularly true for nephron-sparing surgery.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Robotic Surgical Procedures
PubMed: 26351884
DOI: 10.1177/107327481502200306 -
Asian Pacific Journal of Cancer... May 2022The aim of this study is to describe our experience in laparoscopic partial nephrectomy and to compare the differences between off-clamp and on-clamp techniques in terms...
PURPOSE
The aim of this study is to describe our experience in laparoscopic partial nephrectomy and to compare the differences between off-clamp and on-clamp techniques in terms of clinical characteristics and outcomes.
METHODS
A retrospective study was utilized. A purposeful sampling method was used to select the patients. The inclusion criteria for kidney tumors were as follows: exophytic, maximum diameter 3 cm, RENAL score 4 or more, solid or cystic, and suspected of malignancy. Around 32 participants were selected. The data were collected from patient files.
RESULTS
There were no statistically significant differences between the mean of the off-clamp group and the on-clamp group in terms of tumor size, size of the kidney, and the position of the tumor. The average expected blood loss in the off-clamp group was 150.15 +/- 60.25 mL and in the on-clamp group was 75.25+/- 40.11 mL, with a p-value of less than 0.001. There was no statistically significant difference between the two groups in terms of the most common surgical complications, postoperative drainage, overall operation time, renorrhaphy time, and postoperative bedtime.
CONCLUSION
The off-clamp group was shown to have a higher tumor resection duration as well as a higher rate of expected blood loss. The functional result of alterations in the estimated glomerular filtration rate seemed to be better in the off-clamp group. We expect to understand its long-term safety and oncological efficacy better as we continue to use this method.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Retrospective Studies; Treatment Outcome
PubMed: 35633557
DOI: 10.31557/APJCP.2022.23.5.1719