Evaluation of Routine Postoperative Labs Following Robotic Assisted Partial Nephrectomy in Patients with Normal Preoperative Renal Function

Abstract Aim To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours. Method A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes. Results In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups. Conclusions RAPN is a feasible treatment choice in selected T1b renal tumours.

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Clinical experience of using virtual 3D modelling for pre and intraoperative guidance during robotic-assisted partial nephrectomy

Journal of Clinical Urology ◽

10.1177/20514158211000204 ◽

2021 ◽

pp. 205141582110002

Author(s):

Lorenz Berger ◽

Aziz Gulamhusein ◽

Eoin Hyde ◽

Matt Gibb ◽

Teele Kuusk ◽

...

Keyword(s):

Computed Tomography ◽

Partial Nephrectomy ◽

Surgical Outcome ◽

Prospective Cohort ◽

Three Dimensional ◽

Two Dimensional ◽

Dimensional Model ◽

Three Dimensional Model ◽

Robotic Assisted ◽

Robotic Assisted Partial Nephrectomy

Objective: Surgical planning for robotic-assisted partial nephrectomy is widely performed using two-dimensional computed tomography images. It is unclear to what extent two-dimensional images fully simulate surgical anatomy and case complexity. To overcome these limitations, software has been developed to reconstruct three-dimensional models from computed tomography data. We present the results of a feasibility study, to explore the role and practicality of virtual three-dimensional modelling (by Innersight Labs) in the context of surgical utility for preoperative and intraoperative use, as well as improving patient involvement. Methods: A prospective study was conducted on patients undergoing robotic-assisted partial nephrectomy at our high volume kidney cancer centre. Approval from a research ethics committee was obtained. Patient demographics and tumour characteristics were collected. Surgical outcome measures were recorded. The value of the three-dimensional model to the surgeon and patient was assessed using a survey. The prospective cohort was compared against a retrospective cohort and cases were individually matched using RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines) scores. Results: This study included 22 patients. Three-dimensional modelling was found to be safe for this prospective cohort and resulted in good surgical outcome measures. The mean (standard deviation) console time was 158.6 (35) min and warm ischaemia time was 17.3 (6.3) min. The median (interquartile range) estimated blood loss was 125 (50–237.5) ml. Two procedures were converted to radical nephrectomy due to the risk of positive margins during resection. The median (interquartile range) length of stay was 2 (2–3) days. No postoperative complications were noted and all patients had negative surgical margins. Patients reported improved understanding of their procedure using the three-dimensional model. Conclusion: This study shows the potential benefit of three-dimensional modelling technology with positive uptake from surgeons and patients. Benefits are improved perception of vascular anatomy and resection approach, and procedure understanding by patients. A randomised controlled trial is needed to evaluate the technology further. Level of evidence: 2b

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