What are the predictors of oncocytoma histology at pathological analysis after partial nephrectomy for small renal masses? insights from a large prospective multicentre study (record 2 project)

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

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Laparoscopic Cryoablation Versus Partial Nephrectomy for the Treatment of Small Renal Masses: Systematic Review and Cumulative Analysis of Observational Studies

European Urology ◽

10.1016/j.eururo.2011.05.002 ◽

2011 ◽

Vol 60 (3) ◽

pp. 435-443 ◽

Cited By ~ 83

Author(s):

Tobias Klatte ◽

Bernhard Grubmüller ◽

Matthias Waldert ◽

Peter Weibl ◽

Mesut Remzi

Keyword(s):

Systematic Review ◽

Partial Nephrectomy ◽

Observational Studies ◽

Small Renal Masses ◽

Renal Masses

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Modified Nephrometry Score With Body Mass Index More Accurately Predicts Ischemic Time in Transabdominal Laparoscopic Partial Nephrectomy for Small Renal Masses

Urology ◽

10.1016/j.urology.2018.09.002 ◽

2018 ◽

Vol 122 ◽

pp. 104-109

Author(s):

Naoya Masumori ◽

Koji Ichihara ◽

Takeshi Maehana

Keyword(s):

Body Mass Index ◽

Partial Nephrectomy ◽

Body Mass ◽

Laparoscopic Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses ◽

Ischemic Time ◽

Nephrometry Score

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Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Canadian Urological Association Journal ◽

10.5489/cuaj.588 ◽

2013 ◽

Vol 5 (2) ◽

pp. 89

Author(s):

Frédéric Pouliot ◽

Allan Pantuck ◽

Annie Imbeault ◽

Brian Shuch ◽

Brian Calimlim ◽

...

Keyword(s):

Multivariate Analysis ◽

Partial Nephrectomy ◽

Tumour Size ◽

Significant Loss ◽

Differential Function ◽

Small Renal Masses ◽

Renal Masses ◽

Factors Associated ◽

Before And After ◽

Tomography Scan

Background: Partial nephrectomy (PN) is now the gold standardfor the surgical treatment of small renal masses. We evaluated theeffect of WIT and other factors on RDF assessed by preoperativeand postoperative renal scintigraphy.Methods: Between 2003 and 2008, 182 consecutive laparoscopicPN (LPN) were performed in an academic centre. Among those,56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphypreoperatively and postoperatively.Results: Medians for age, preoperative estimated glomerular filtrationrate and computed tomography scan tumour size were 62years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WITand preoperative RDF were 30 minutes and 50%, respectively.Median loss of RDF after surgery was 14%. Linear regression curvesshowed that loss in RDF rate was 0.2% per minute when WIT was<30 minutes and 0.7% per minute when WIT was ≥30 minutes.In multivariate analysis, length of WIT and endophytic tumourlocation were associated with a statistically significant loss of RDF(p < 0.05), but only in the group who experienced >30 minutesof WIT.Interpretation: Our results suggest that the factors associated withloss of RDF are not the same before and after 30 minutes of WITand that the rate of loss in RDF increases after 30 minutes. Since,the effect of WIT is small up to 30 minutes, we believe that surgeryshould focus on limiting the resection of normal parenchymaand to ensure negative margins and hemostasis, rather than onpremature unclamping.

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