Comparison of Laparoscopic and Open Partial Nephrectomy in Clinical T1a Renal Tumors

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.

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Cost comparison of robotic, laparoscopic, and open partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.394 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 394-394

Author(s):

Mehrdad Alemozaffar ◽

Steven Lee Chang ◽

Ravi Kacker ◽

Maryellen Sun ◽

William C DeWolf ◽

...

Keyword(s):

Sensitivity Analysis ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Hospital Costs ◽

Cost Comparison ◽

Renal Tumors ◽

Robotic Partial Nephrectomy ◽

Fixed Costs ◽

Average Hospital ◽

Open Partial Nephrectomy

394 Background: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are increasingly common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. The cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. Methods: Variable hospital costs including operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory charges were captured for 25 patients who underwent OPN, LPN, and RPN at our institution between 11/2008 -9/2010. Fixed costs of acquisition of a laparoscopic suite and a robotic system (including maintenance) were amortized over 7 years. We considered alternative scenarios through one-way and multi-way sensitivity analysis. Results: We found similar overall variable costs for OPN, LPN, and RPN. Sensitivity analysis demonstrated that RPN and LPN are more cost effective than OPN (excluding fixed costs) if the average hospital stay is < 2 days, or OR time less is than 204 and 196 mins, respectively. By including fixed costs of equipment, RPN and LPN are always more costly than OPN. Conclusions: There was no difference among variable hospital costs of OPN, LPN, and RPN. Minimizing OR time and hospital stay reduces RPN and LPN costs to levels comparable to OPN. Inclusion of fixed costs makes LPN and RPN more expensive than OPN, but increased utilization and efficiency can decrease cost per case. [Table: see text]

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Pringle maneuver during open partial nephrectomy for renal tumors

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2017.3.2 ◽

2017 ◽

Vol 12 (3) ◽

pp. 136-140

Author(s):

Adrian HASEGAN ◽

◽

Dan BRATU ◽

Valentin PIRVUT ◽

Ionela MIHAI ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Kidney Tissue ◽

Operation Time ◽

Good Control ◽

Pringle Maneuver ◽

Renal Tumors ◽

Open Partial Nephrectomy ◽

Renal Pedicle ◽

Tumor Pathology

Introduction. Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease after surgery than patients who received a kidney-sparing partial nephrectomy. The aim of study is to show the effectives of Pringle maneuver for clamping renal pedicle in order to minimize warm ischemia during open partial nephrectomy. Material and method. We retrospectively analyzed 34 patients diagnosed with cT1 renal tumors between 2012 and 2016 and underwent open partial nephrectomy in Sibiu Urology Department. During the surgery we perform clamping of renal pedicle with Satinsky clamp or with the Pringle maneuver. We analyzed the flowing parameters: operation time, blood loss, clamping time and serum creatinine before and after the surgery. Results. The mean age of patient with partial nephrectomy was 58.7±14.7 years, with 56.7±12.4 years for Satinsky group and 60.5±11.6 for Pringle group. The average duration for partial nephrectomy was 94.8±19.4 minutes. Average blood loss for all surgeries was 220±30 ml. Conclusion. Pringle maneuver is a safe and effective method with low intra and postoperative complications during open partial nephrectomy, having a good control of the renal pedical with reduced ischemia. Is a feasible method of choice in renal tumour tumor pathology on a single congenital or surgical kidney, mediorenal tumors or near the sinus and multifocal tumors.

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PD20-04 PERIOPERATIVE OUTCOMES OF ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR MODERATELY AND HIGHLY COMPLEX T1B RENAL TUMORS

The Journal of Urology ◽

10.1016/j.juro.2017.02.890 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Önder Kara ◽

Matthew J. Maurice ◽

Pascal Mouracade ◽

Ercan Malkoç ◽

Julien Dagenais ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Open Partial Nephrectomy

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Comparison of robotic and open partial nephrectomy for highly complex renal tumors (RENAL nephrometry score ≥10)

PLoS ONE ◽

10.1371/journal.pone.0210413 ◽

2019 ◽

Vol 14 (1) ◽

pp. e0210413 ◽

Cited By ~ 1

Author(s):

Jung Kwon Kim ◽

Hakmin Lee ◽

Jong Jin Oh ◽

Sangchul Lee ◽

Sung Kyu Hong ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Open Partial Nephrectomy ◽

Nephrometry Score

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Microwave Thermal Ablation versus Open Partial Nephrectomy for the Treatment of Small Renal Tumors in Patients Over 70 Years Old

Medicina ◽

10.3390/medicina55100664 ◽

2019 ◽

Vol 55 (10) ◽

pp. 664 ◽

Cited By ~ 1

Author(s):

Anglickis ◽

Anglickienė ◽

Andreikaitė ◽

Skrebūnas

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Thermal Ablation ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Hemoglobin Level ◽

Renal Tumors ◽

Open Partial Nephrectomy

Background and objectives: Microwave thermal ablation (MWT) is one of the treatment options for kidney cancer. However, for patients over 70 years old the safety and oncological efficacy of this treatment is still controversial. The goal of this study was to compare MWT with open partial nephrectomy (OPN) and to find out whether MWT is preferable in maintaining patient renal function and reducing the risk of postoperative complications. Materials and Methods: Depending on the treatment choice, all patients were divided into two groups: an MWT group and an open kidney resection (OPN) group. Data have been retrospectively collected for 7 years, starting with January 2012 up to January 2019. A total number of 33 patients with exophytic, single small renal masses were treated with either OPN (n = 18) or MWT (n = 15). All patients had histologically proven T1 kidney cancer. MWT was performed for patients who refused to have OPN or in those cases where the collecting system, renal calyx, and great vessels were free from tumor margins of more than 1 cm. Results: In the MWT group a median (IQR) patients’ age was 75 years (71–79) years, in the OPN group—71.5 (70–75) years, p = 0.005. A median (IQR) Charleston comorbidity index in the MWT group was 7.5 (5–10) and in the same way in the OPN group it was 5.22 (5–6), p = 0.005. A median (IQR) estimated glomerular filtration rate (eGFR) before surgery was higher in the MWT group 59.9 (49.5–73.8) mL/min/1.73 m2 vs. 46.2 (42.7–65.8) mL/min/1.73 m2 in the OPN group, p = 0.12. Three days following the surgery a median (IQR) eGFR was 56.45 (46.6–71.9) in MWT group mL/min/1.73 m2 vs. 43.45 (38.3–65) mL/min/1.73 m2) in the OPN group, p = 0.30. A median (IQR) of primary hemoglobin level was lower in the MWT group compared with the OPN group (134.5 (124–140) g/L vs. 125 (108–138) g/L), p = 0.41. However, after the surgery a median (IQR) lower hemoglobin level was detected in the OPN group (123.5 (111–134) g/L vs. 126 (112–135)), p = 0.53. The median (IQR) duration of the procedure in MWT group was shorter compared with the OPN group (26 (25–30) min vs. 67.5 (55–90) min), p < 0.0001. A median (IQR) hospitalization time was shorter in MWT group (3 (2–3) days vs. 89 (7–11.5) days), p < 0.0001. Pain by the visual analogue scale (VAS) scale the first day after surgery was significantly lower—median (IQR) in the MWT group was 2 (1–3) vs. 4 (3–6)), p = 0.008. Treatment failure rate was numerically higher in MWT (1/15 vs. 0/18, p = 0.56). Conclusions: Pain level on the next day after surgery, mean number of hospitalization and operation time were significantly lower in the MWT group than in the OPN group. The blood loss estimated glomerular filtration rate and oncologic data between the two groups was not statistically significant.

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