Contemporary rates and predictors of open conversion during minimally invasive partial nephrectomy for kidney cancer

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

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Needle Adjustment Free (NAF) running suture technique (PAN suture) in laparoscopic partial nephrectomy

BMC Surgery ◽

10.1186/s12893-021-01112-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jun-wei Pan ◽

Xiang Zhang ◽

Xing-wei Jin ◽

Xiao Liu ◽

Wei-chao Tu ◽

...

Keyword(s):

Partial Nephrectomy ◽

Conversion Rate ◽

Suture Technique ◽

Laparoscopic Partial Nephrectomy ◽

Continuous Suture ◽

Discharge Time ◽

Open Conversion ◽

Traditional Technique ◽

Affected Side ◽

Suture Group

Abstract 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.

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MP59-18 COMPREHENSIVE ASSESSMENT OF CONTEMPORARY SHORT-, INTERMEDIATE-, AND LONG-TERM ENDPOINTS AFTER EITHER PARTIAL NEPHRECTOMY OR MINIMALLY-INVASIVE RADICAL NEPHRECTOMY

The Journal of Urology ◽

10.1016/j.juro.2015.02.2178 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Maxine Sun ◽

Giorgio Gandaglia ◽

Jonas Schiffmann ◽

Simon Kim ◽

Alessandro Larcher ◽

...

Keyword(s):

Minimally Invasive ◽

Partial Nephrectomy ◽

Radical Nephrectomy ◽

Comprehensive Assessment

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PP164 Identifying Complications Of Partial Nephrectomy Using Physician Claims

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646231800288x ◽

2018 ◽

Vol 34 (S1) ◽

pp. 130-131

Author(s):

Jian Sun ◽

Tania Stafinski ◽

Fernanda Inagaki Nagase ◽

Devidas Menon

Keyword(s):

Ambulatory Care ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

International Classification Of Diseases ◽

Population Based ◽

Incidence Rates ◽

Open Group ◽

Robot Assisted ◽

Before And After ◽

Chi Squared

Introduction:Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.Methods:Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.Results:A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.Conclusions:Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.

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