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Revista Da Associacao Medica Brasileira... 2023The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in...
OBJECTIVE
The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery.
METHODS
Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups.
RESULTS
The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant.
CONCLUSION
A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.
Topics: Humans; Robotic Surgical Procedures; Kidney Neoplasms; Retrospective Studies; Treatment Outcome; Nephrectomy; Ischemia
PubMed: 38055454
DOI: 10.1590/1806-9282.20230825 -
Urology Feb 2014A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy.... (Review)
Review
A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation.
Topics: Forecasting; Humans; Nephrectomy; Robotics; Surgery, Computer-Assisted
PubMed: 24149104
DOI: 10.1016/j.urology.2013.08.049 -
European Urology Oncology Aug 2021Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative...
BACKGROUND
Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated.
OBJECTIVE
To assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN.
DESIGN, SETTING, AND PARTICIPANTS
Data of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE] criteria) according to age, baseline renal function, clinical stage, preoperative aspects and dimensions used for an anatomical (PADUA) score, and surgical approach. Classification and regression tree (CART) analysis identified patients at "high" and "low" risk of AKI. Finally, we plotted the probability of AKI over ischemia time stratified by the preoperative risk of AKI.
RESULTS AND LIMITATIONS
Overall, 235 (25%) patients experienced AKI after surgery. At multivariable analysis, older patients, those with more complex tumors, those with higher baseline function, and those treated with open surgery had an increased risk of AKI (all p ≤ 0.011). According to the first split at CART analysis, patients were categorized as those with "high" and "low" risk of AKI having a probability of >40% or <40%. For low-risk patients, the probability of AKI in case of <10 versus >20 min of ischemia was 13% versus 28% (absolute risk increase 15%). The risk of AKI for high-risk patients who had <10 versus >20 min of ischemia was 31% versus 77%. This corresponds to an absolute risk increase of 45%. Limitations include retrospective data analyses and lack of surgeons' prior experience.
CONCLUSIONS
Ischemia time during PN has different implications for patients with different health status. Clamp time seems less clinically relevant for patients in good conditions who may endure prolonged ischemia with a mild increase in the risk of AKI, whereas frail patients seem to be more vulnerable to ischemic damage even for short clamp time. For individualized intra- and postoperative management, duration of ischemia needs to be questioned in the context of the individual health status.
PATIENT SUMMARY
Functional sequelae related to ischemia time during partial nephrectomy depend on baseline health status. The correlation between the duration of ischemia and baseline health status should be taken into account toward individualized intra- and postoperative management.
Topics: Health Status; Humans; Ischemia; Nephrectomy; Prospective Studies; Retrospective Studies
PubMed: 32646849
DOI: 10.1016/j.euo.2020.05.009 -
JSLS : Journal of the Society of... 2012To compare postoperative complications in patients undergoing laparoscopic and open partial nephrectomy using a standardized complication-reporting system and a... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
To compare postoperative complications in patients undergoing laparoscopic and open partial nephrectomy using a standardized complication-reporting system and a standardized tumor-scoring system.
METHODS
We conducted a retrospective analysis of 189 consecutive patients with nephrometry scores available who underwent elective partial nephrectomy for renal masses. Demographic, perioperative, and complication data were recorded. By using the modified Clavien scale, we graded 30- and 90-day complication rates.
RESULTS
107 patients underwent laparoscopic partial nephrectomy and 82 underwent open partial nephrectomy (N=189). Open partial nephrectomy patients had higher nephrometry scores than laparoscopic patients had (7.1±2.4 vs. 5.6±1.8, P<.001). Surgical and hospitalization times were shorter, and estimated blood loss was lower in the laparoscopic group (P<.001). At 30 days, there were more overall complications in the open group, but more major complications in the laparoscopic group (P>.05). After multivariable logistic regression analysis, only higher body mass index and higher estimated blood loss were predictors of more overall complications.
CONCLUSIONS
Laparoscopic partial nephrectomy has the advantages of decreased operative time, lower blood loss, and shorter hospital stay. The complication rate in the laparoscopic group is similar to that in the open group, despite favorable tumor characteristics in the laparoscopic group.
Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Female; Humans; Kidney Neoplasms; Laparoscopy; Logistic Models; Male; Middle Aged; Nephrectomy; Postoperative Complications; Retrospective Studies; Risk Factors; Young Adult
PubMed: 22906328
DOI: 10.4293/108680812X13291597716942 -
Journal of Robotic Surgery Jun 2024While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially... (Comparative Study)
Comparative Study
While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.
Topics: Humans; Nephrectomy; Aneurysm, False; Robotic Surgical Procedures; Male; Female; Middle Aged; Laparoscopy; Retrospective Studies; Postoperative Complications; Aged; Renal Artery; Kidney Neoplasms; Incidence; Treatment Outcome; Embolization, Therapeutic
PubMed: 38833079
DOI: 10.1007/s11701-024-01999-3 -
Urologic Oncology Jul 2022To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors.
MATERIALS AND METHODS
Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors.
RESULTS
Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors.
CONCLUSIONS
AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Neoplasm Staging; Nephrectomy; Retrospective Studies; Treatment Outcome
PubMed: 35562311
DOI: 10.1016/j.urolonc.2022.04.002 -
BMC Surgery Mar 2021It is proposed a new running suture technique called Needle Adjustment Free (NAF) technique, or PAN suture. The efficiency and the safety were evaluated in laparoscopic...
BACKGROUND
It is proposed a new running suture technique called Needle Adjustment Free (NAF) technique, or PAN suture. The efficiency and the safety were evaluated in laparoscopic partial nephrectomy.
METHODS
This new running suture technique avoids the Needle Adjustment method used in traditional techniques. The new continuous suture technique (11 patients) was compared with the traditional continuous suture method (33 patients) used in both transperitoneal and retroperitoneal laparoscopic partial nephrectomy (LPN) in terms of suture time (ST), warm ischemia time (WIT), blood loss (BL), open conversion rate and post-op discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). Differences were considered significant when P < 0.05.
RESULTS
ST in the PAN suture group was 30.37 ± 16.39 min, which was significant shorter (P = 0.0011) than in the traditional technique group which was 13.68 ± 3.33 min. WIT in the traditional technique group was 28.73 ± 7.89 min, while in the PAN suture group was 20.64 ± 5.04 min, P = 0.0028. The BL in entirety in the traditional technique group was 141.56 ± 155.23 mL, and in the PAN suture group was 43.18 ± 31.17 mL (P = 0.0017). BL in patients without massive bleeding in the traditional technique group was significantly greater than in the PAN suture group at 101.03 ± 68.73 mL versus 43.18 ± 31.17 mL (P = 0.0008). The open conversion rate was 0 % in both groups. There was no significant difference between the two groups in postoperative discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op).
CONCLUSIONS
The NAF running suture technique, or PAN suture, leading to less ST, WIT and BL, which was shown to be more effective and safer than the traditional technique used for LPN. A further expanded research with larger sample size is needed.
Topics: Humans; Laparoscopy; Nephrectomy; Suture Techniques; Treatment Outcome
PubMed: 33676481
DOI: 10.1186/s12893-021-01112-7 -
Archivos Espanoles de Urologia Apr 2019Robot assisted partial nephrectomy (RAPN) is a minimally invasive option for patients with small renal masses undergoing partial nephrectomy. In this review we provide...
OBJECTIVE
Robot assisted partial nephrectomy (RAPN) is a minimally invasive option for patients with small renal masses undergoing partial nephrectomy. In this review we provide an update on the oncological safety and renal functional outcomes following RAPN. We also discuss the novel techniques and technological advances that have contributed to the outcomes of RAPN. METHODS: A Medline search using the keywords "partial nephrectomy", "robotic partial nephrectomy", "robot assisted partial nephrectomy", "robot assisted laparoscopic partial nephrectomy" and "laparoscopic partial nephrectomy" was conducted to identify original articles, review articles, and editorials on RAPN.
RESULTS
A review of the literature suggests that RAPNis emerging as the preferred approach to minimally invasive nephron sparing surgery. RAPN is superior to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in terms of perioperative outcomes with equivalent mid-term oncological outcomes. RAPN has proven safety and efficacy even in complex renal tumors with equivalent oncological and functional outcomes. Novel techniques and advances in technology have contributed to the safety and efficacy of RAPN. CONCLUSION: RAPN can be considered to be the gold standard approach to minimally invasive nephronsparing surgery with equivalent oncological and renal functional outcomes and superior perioperative outcomes when compared to OPN. Newer techniques and developments in robotic technology have contributed to improved outcomes following RAPN.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 30945655
DOI: No ID Found -
Journal of Endourology 2005The technique of laparoscopic partial nephrectomy has matured significantly over the past decade and is emerging as an oncologically sound procedure for the management... (Comparative Study)
Comparative Study Review
BACKGROUND AND PURPOSE
The technique of laparoscopic partial nephrectomy has matured significantly over the past decade and is emerging as an oncologically sound procedure for the management of small renal tumors. Methods of tumor excision as well as parenchymal reconstruction in a hemostatically controlled field have evolved to make this procedure safer. Improved techniques to minimize warm renal ischemia are being developed. Finally, methods to prevent positive surgical margins during laparoscopic surgery are crucial to a satisfactory oncologic outcome. These important technical issues, as well as the current results of laparoscopic partial nephrectomy, are discussed.
MATERIALS AND METHODS
The urologic peer-review literature related to nephron-sparing surgery was reviewed. Controversial issues with respect to the surgical approach, methods of hemostatic control, acceptable time of warm ischemia, and cooling techniques were reviewed and collated. Perioperative results from larger series of laparoscopic and open partial nephrectomy were evaluated.
RESULTS
Open nephron-sparing surgery for renal tumors < or =4 cm has cancer control equivalent to that of open radical nephrectomy. Evidence is now emerging that laparoscopic partial nephrectomy will provide similar oncologic results, although clinical follow-up is still early. Blood loss, postoperative pain, and convalescence seem to be favor the laparoscopic approach. Complication rates, primarily postoperative bleeding and urine leak, may be higher than for open nephron-sparing surgery. Methods of laparoscopic hemostatic control favor soft vascular clamping for larger tumors that are more endophytic and central. Smaller exophytic lesions may be managed without renal vascular control using a variety of coagulative and hemostatic tools. Data related to warm renal ischemia suggest that the time used for tumor excision and renal reconstruction should be 30 minutes or less. Techniques for laparoscopic renal cooling are being developed.
CONCLUSIONS
Laparoscopic nephron-sparing surgery is a technique in evolution but with a promising outlook. The urologic peer-review literature reflects an exponential growth in interest, which suggests that this minimally invasive approach is practical and may benefit our patient population so as to allow them to return to normal healthy living more quickly.
Topics: Adult; Aged; Female; Hemostasis, Surgical; Humans; Intraoperative Complications; Kidney Neoplasms; Laparoscopy; Magnetic Resonance Imaging; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Staging; Nephrectomy; Prognosis; Risk Assessment; Sensitivity and Specificity; Survival Analysis; Treatment Outcome
PubMed: 16053351
DOI: 10.1089/end.2005.19.634 -
PloS One 2019Intraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Intraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such systems, the first question to be asked is: What information does the surgeon need and when does he or she need it? In this article, we present an approach to investigate these surgeon information needs for minimally invasive partial nephrectomy and compare these needs to the relevant surgical computer assistance literature.
MATERIALS AND METHODS
First, we conducted a literature-based hierarchical task analysis of the surgical procedure. This task analysis was taken as a basis for a qualitative in-depth interview study with nine experienced surgical urologists. The study employed a cognitive task analysis method to elicit surgeons' information needs during minimally invasive partial nephrectomy. Finally, a systematic literature search was conducted to review proposed software assistance solutions for minimally invasive partial nephrectomy. The review focused on what information the solutions present to the surgeon and what phase of the surgery they aim to support.
RESULTS
The task analysis yielded a workflow description for minimally invasive partial nephrectomy. During the subsequent interview study, we identified three challenging phases of the procedure, which may particularly benefit from software assistance. These phases are I. Hilar and vascular management, II. Tumour excision, and III. Repair of the renal defects. Between these phases, 25 individual challenges were found which define the surgeon information needs. The literature review identified 34 relevant publications, all of which aim to support the surgeon in hilar and vascular management (phase I) or tumour excision (phase II).
CONCLUSION
The work presented in this article identified unmet surgeon information needs in minimally invasive partial nephrectomy. Namely, our results suggest that future solutions should address the repair of renal defects (phase III) or put more focus on the renal collecting system as a critical anatomical structure.
Topics: Minimally Invasive Surgical Procedures; Nephrectomy; Software; Surgeons; Surgery, Computer-Assisted; Workflow
PubMed: 31318919
DOI: 10.1371/journal.pone.0219920