1434 IDENTIFYING COLLECTING SYSTEM ENTRY AND THE INTEGRITY OF REPAIR DURING OPEN PARTIAL NEPHRECTOMY: COMPARISON OF TWO TECHNIQUES

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Sammy Moussly ◽  
Sandhya R. Rao ◽  
Michelle Pacheco ◽  
Philippe E. Spiess ◽  
Wade J. Sexton
Keyword(s):  
Partial Nephrectomy ◽  
Open Partial Nephrectomy ◽  
Collecting System

scholarly journals The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

2013 ◽  
Vol 7 (3-4) ◽  
pp. e207-14 ◽  
Author(s):  
Luke T. Lavallée ◽  
Darren Desantis ◽  
Fadi Kamal ◽  
Brian Blew ◽  
James Watterson ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Scoring Systems ◽  
Renal Tumour ◽  
Smoking History ◽  
Widespread Application ◽  
Open Partial Nephrectomy ◽  
Ischemia Time ◽  
Tumour Characteristics ◽  
Collecting System ◽  
Anterior Posterior

Objective: To evaluate the association between renal tumour scoring systems and open partial nephrectomy ischemia time.Methods: A historical cohort of open partial nephrectomy patients at The Ottawa Hospital between 2002 and 2009 was reviewed. Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded.Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant.Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application.

scholarly journals Identifying unrecognized collecting system entry and the integrity of repair during open partial nephrectomy: comparison of two techniques

2014 ◽  
Vol 40 (5) ◽  
pp. 637-643 ◽  
Author(s):  
Sandhya R. Rao ◽  
Sammy Moussly ◽  
Michelle Pacheco ◽  
Philippe E. Spiess ◽  
Wade J. Sexton
Keyword(s):  
Partial Nephrectomy ◽  
Open Partial Nephrectomy ◽  
Collecting System

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

2021 ◽  
pp. 039156032110016
Author(s):  
Francesco Chiancone ◽  
Marco Fabiano ◽  
Clemente Meccariello ◽  
Maurizio Fedelini ◽  
Francesco Persico ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operation Time ◽  
Renal Tumors ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Open Partial Nephrectomy

Renal Cancer ◽  
2019 ◽  
pp. 221-242
Author(s):  
Marianne M. Casilla-Lennon ◽  
Patrick A. Kenney ◽  
Matthew Wszolek ◽  
John A. Libertino
Keyword(s):  
Partial Nephrectomy ◽  
Open Partial Nephrectomy

scholarly journals Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

2014 ◽  
Vol 8 (3-4) ◽  
pp. 137
Author(s):  
Dong Soo Park ◽  
Jin Ho Hwang ◽  
Moon Hyung Kang ◽  
Jong Jin Oh
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Renal Neoplasm ◽  
Cold Ischemia ◽  
Ischemic Time ◽  
Open Partial Nephrectomy ◽  
Cold Ischemic Time ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

1790 RENAL PELVIC ANATOMY IS ASSOCIATED WITH URINE LEAK FOLLOWING OPEN PARTIAL NEPHRECTOMY

2013 ◽  
Vol 189 (4S) ◽  
Author(s):  
Jeffrey Tomaszewski ◽  
Marc Smaldone ◽  
Bic Cung ◽  
Reza Mehrazin ◽  
Anthony Corcoran ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Pelvic Anatomy ◽  
Open Partial Nephrectomy ◽  
Urine Leak

scholarly journals Open partial nephrectomy: An ideal modular based training operation?

2013 ◽  
Vol 11 (8) ◽  
pp. 728
Author(s):  
Ai Lok ◽  
Victoria Rebecca Lewis ◽  
Gana Kugathasan ◽  
Dickon Hayne ◽  
Nicholas John Rukin ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Open Partial Nephrectomy

scholarly journals Chyluria after Partial Nephrectomy: Case Report and Review of the Literature

2009 ◽  
Vol 9 ◽  
pp. 1-4 ◽  
Author(s):  
Ronald J. Kim ◽  
Fadi N. Joudi
Keyword(s):  
Case Report ◽  
Partial Nephrectomy ◽  
Renal Mass ◽  
Chain Fatty Acid ◽  
Review Of The Literature ◽  
Open Partial Nephrectomy ◽  
Acid Diet ◽  
Fluid Analysis ◽  
Surgical Options ◽  
Ureteral Stenting

We report a case of 61-year-old male who presented with chyluria after partial nephrectomy. During workup for appendicitis, an incidental exophytic renal mass was revealed on CT scan. The patient ultimately underwent uncomplicated open partial nephrectomy. Postoperatively, his JP drain output turned milky white with urine remaining clear. JP fluid analysis was consistent with lymph. At 3 weeks postsurgery, his drain output decreased, but his urine turned milky white. Urinalysis confirmed fat in the urine. CT imaging revealed chyloma/urinoma with extravasation. The patient was initially treated conservatively, with a medium-chain fatty acid diet and then ureteral stenting. His stent was eventually removed and his chlyuria resolved 14 weeks later.In nonendemic countries, nonparasitic chyluria is exceedingly rare and postsurgical chyluria even more so. We review the sequelae of untreated disease and surgical options for intractable chyluria not responsive to conservative management.In non-endemic countries, non-parasitic chyluria is exceedingly rare, and post surgical chyluria even more so. We review the sequelae of untreated disease and surgical options for intractable chyluria not responsive to conservative management.

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