Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.

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Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single-site Donor Nephrectomy

10.21203/rs.3.rs-111078/v1 ◽

2020 ◽

Author(s):

Chung-Yu Lin ◽

Ching-Chia Li ◽

Hung-Lung Ke ◽

Wen-Jeng Wu ◽

Yii-Her Chou ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Operation Time ◽

Warm Ischemia ◽

Donor Nephrectomy ◽

Warm Ischemia Time ◽

Single Site ◽

Perioperative Outcomes ◽

Ischemia Time ◽

Laparoendoscopic Single Site

Abstract Background: Laparoscopic living-donor nephrectomy is the standard technique at high-volume renal transplant centers. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a relatively novel minimally invasive surgery, which was differed to transperitoneal and retroperitoneal approaches. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN with regards to operative outcomes.Materials and Methods: Ten patients who underwent LESS-DN from 2017–2019 were enrolled at our center. The same surgeon performed all cases. The two approaches were compared retrospectively and evaluated for differences in perioperative outcomes, including operation time, console time, blood loss, graft warm ischemia time, postoperative pain, length of stay (LOS), wound size, postoperative pain, and renal function post LESS-DN at less than one year.Results: Total operating time (315 ± 82.69 vs. 191 ± 24.9 min, p = 0.016), console time (224 ± 74.15 vs. 110 ± 19.84 min, p = 0.016), and LOS (8.4 ± 1.82 vs. 4.8 ± 1.10 days, p = 0.013) were significantly longer in the transperitoneal group. The wound size (44 ± 3.81 vs. 68.2 ± 13.5 mm, p = 0.038) was significantly smaller in the transperitoneal group. There was no significant difference in other parameters, including blood loss, warm ischemia time, and postoperative pain from day one to day three.Conclusions: Retroperitoneal LESS-DN results in similar perioperative outcomes as transperitoneal LESS-DN without compromising donor safety, and while providing a faster operation time, console time, shorter LOS, and a trend toward a shorter warm ischemia time.

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Organ-preserving surgery for localized renal cell carcinoma: Current approaches.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16077 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16077-e16077

Author(s):

Sergey N Dimitriadi ◽

Oleg Ivanovich Kit ◽

Elena Mikhaylovna Frantsiyants ◽

Natalya Dmitrievna Ushakova ◽

Dmitry Rozenko ◽

...

Keyword(s):

Acute Kidney Injury ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Renal Cancer ◽

Kidney Injury ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Ischemia Time ◽

Delayed Bleeding ◽

Localized Renal Cell Carcinoma

e16077 Background: Introduction of modern organ-preservingapproaches in surgical treatment of kidney cancer is limited by the duration of warm ischemia used during the partial nephrectomy (PN), including surgery for elective indications. Some resection procedures require prolonged warm ischemia time resulting in acute kidney injury and development of renal failure in the postoperative period. The purpose of the study was to analyze the effectiveness of a new organ-preserving surgery method for kidney cancer. Methods: 46 patients with clinically localized renal cancer, R.E.N.A.L. score 6-10, underwent PN for elective indications. Patients were divided into two groups: the first group – 20 patients (8 patients – laparoscopic PN (LPN), 12 – open PN (OPN)) with bilateral perirenal procaine blockade (BPPB) before the resection. The second group included 26 patients (19- LPN, 7– OPN) receiving surgery without BPPB. BPPB was performed under US-control. 50 ml of 0.25% procaine solution was successively injected to the perinephric fat in upper, middle and lower kidney segments at both sides. Acute kidney injury (AKI) was diagnosed by serum creatinine level increase by 50% of the initial level and higher. Results: Patients in both groups were comparable by age – 58.35±7.5 (44–70) and 58.7±5.6 (50–65) years, and resection difficulty by R.E.N.A.L. score – 7.35±1.1 (6–10) and 7.15±1.2 (6–10), respectively. Median warm ischemia time did not differ significantly in both groups and was 20.0±2.99 (15–25) and 18.42±2.93 (15–25) min., respectively. Morphologically, all patients were diagnosed with renal cancer, surgical margins were negative. 9 (34.6%) patients of the second group developed AKI, while no AKI was registered in the first group. Urinary fistula and delayed bleeding were not observed. Conclusions: The results suppose renal protective effect of BPPB during partial nephrectomy for kidney cancer with warm ischemia time of 15-25-minutes.

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Single-Port Sutureless Partial Nephrectomy for Small Renal Cancer

10.21203/rs.2.23118/v1 ◽

2020 ◽

Author(s):

Ching-Chia Li ◽

Tsu-Ming Chien ◽

Hsin-Chih Yeh ◽

Hsiang-Ying Lee ◽

Hung-Lung Ke ◽

...

Keyword(s):

Learning Curve ◽

Partial Nephrectomy ◽

Renal Cancer ◽

Single Port ◽

Surgical Margin ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Positive Surgical Margin ◽

Ischemia Time ◽

Custom Made

Abstract Background: Laparoscopic single-port (LESS) sutureless partial nephrectomy (PN) is a technically demanding procedure. Here we shared our experience to reduce the warm ischemia time and shorten the learning curve in performing LESS sutureless PN.Materials and methods: Between 2015 and 2018, custom made LESS sutureless PN was performed in 33 patients with small renal cancer. Preoperative, intra-operative and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively.Results: The average warm ischemia time and the operation time were 11.8 ± 3.9 min and 167.9 ± 37.5 min, respectively. Only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after the surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-up of 16.5 ± 6.4 months.Conclusions: LESS sutureless PN is a feasible surgical method for most patients with small renal cancer with excellent cosmetic results, shorter learning curve without affecting oncological results.

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PENTAFECTA OUTCOME IN INITIAL 30 CASES OF ROBOT ASSISTED PARTIAL NEPHRECTOMY – OUR EXPERIENCE

10.36106/ijar/3201669 ◽

2020 ◽

pp. 40-41

Author(s):

Jeevan Kumar ◽

Farhana Zakaria ◽

Altaf Khan ◽

Lavanya Raghu Sarath P ◽

Mujeeburahiman M

Keyword(s):

Partial Nephrectomy ◽

Surgical Complications ◽

Surgical Margin ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Renal Tumors ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Effective Treatment Option ◽

Ischemia Time

Objectives: To study the Pentafecta outcome of initial 30 cases of Robot Assisted Partial Nephrectomy (RAPN) at our institute. Materials and Methods: A total of 30 patients who underwent Robot assisted partial nephrectomy between January 2016 and June 2018 were prospectively analyzed. The Pentafecta outcome was defined as a warm ischemia time (WIT) of <25 min, negative surgical margins, no surgical complications, > 90% of eGFR preservation & no CKD upstaging. Results: All patients successfully underwent robot assisted partial nephrectomy. Median warm ischemia time was 24.5 minutes. One patient with complex tumour had positive surgical margin. There were no Clavien- Dindo Grade IV and V complications. Grade I-III complications were seen in 20% of patients. Conclusion: RAPN is safe and effective treatment option for renal tumors and it helps in improving pentafecta outcome.

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