Comparison Studies of “Ultrathin Parenchyma” Resection and Sharp Dissection in Robotic Partial Nephrectomy for Renal Tumors

AbstractThere are several nephrometry scoring systems for predicting surgical complexity and potential perioperative morbidity. The R.E.N.A.L. scoring system, one of the most well-known nephrometry scoring systems, emphasizes the features on which it is based (Radius, Exophytic/endophytic, Nearness to collecting system or sinus, Anterior/posterior, and Location relative to polar lines). The ability of these nephrometry scoring systems to predict loss of renal function after robotic partial nephrectomy (RPN) remains controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n = 163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥ 20% from baseline to 6 months after RPN. Multivariable logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariable analyses indicated that tumor volume (cutoff value ≥ 14.11 cm3, indicating a sphere with a diameter ≥ approximately 3 cm) and tumor crossing of the axial renal midline were independent factors associated with a reduced eGFR (odds ratio [OR] 4.57; 95% confidence interval [CI] 1.69–12.30; P = 0.003 and OR 3.50; 95% CI 1.30–9.46; P = 0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC = 0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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Robotic partial nephrectomy: A promising treatment option for T1b and complex renal tumors?

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.07.004 ◽

2013 ◽

Vol 39 (10) ◽

pp. 1167 ◽

Cited By ~ 2

Author(s):

M. Borghesi ◽

E. Brunocilla ◽

R. Schiavina ◽

G. Martorana

Keyword(s):

Partial Nephrectomy ◽

Treatment Option ◽

Renal Tumors ◽

Robotic Partial Nephrectomy ◽

Promising Treatment

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Robotic Partial Nephrectomy for Completely Endophytic and Hilar Renal Tumors

Videourology ◽

10.1089/vid.2020.0049 ◽

2020 ◽

Vol 34 (6) ◽

Author(s):

Alp Tuna Beksac ◽

Kirolos Meilika ◽

Kennedy Okhawere ◽

Ketan K. Badani

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Robotic Partial Nephrectomy

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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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ICG marked off-C robotic partial nephrectomy for endophytic renal tumors: Proof of concept and initial series

European Urology Supplements ◽

10.1016/s1569-9056(18)31352-6 ◽

2018 ◽

Vol 17 (2) ◽

pp. e747

Author(s):

G. Simone ◽

L. Misuraca ◽

G. Tuderti ◽

M. Ferriero ◽

F. Minisola ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Robotic Partial Nephrectomy ◽

Proof Of Concept ◽

Initial Series

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Comparison Robotic versus laparoscopic partial nephrectomy for Complex Renal Tumors (with a RENAL nephrometry score≥7): a meta-analysis

10.21203/rs.3.rs-90761/v1 ◽

2020 ◽

Author(s):

Yu-Li Jiang ◽

Xin Xiao ◽

Fu-Sheng Peng ◽

Tian-Li Shi ◽

Xiao-Hui Huang ◽

...

Keyword(s):

Partial Nephrectomy ◽

Operating Time ◽

Surgical Margin ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Cochrane Central Register ◽

Intraoperative Complication ◽

Estimated Blood Loss

Abstract BackgroundTo compare the perioperative outcomes of Robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN). MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes RPN and LPN in patients with a RENALnephrometry score≥7. We used RevMan 5.2 to pool the data. ResultsSeven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: WMD: 34.49, 95% CI -75.16-144.14, p=0.54), hospital stay (WMD: -0.59 95% CI -1.24–0.06, p=0.07), operating time (WMD: -22.45, 95%CI: -35.06 to-9.85, ), postive surgical margin (OR: 0.85, 95% CI 0.65–1.11, p =0.23) and transfusion (OR: 0.72, 95% CI 0.48–1.08, p =0.11).between the two groups. RPN get better outcomes in postoperative renal function (WMD: 3.32, 95% CI 0.73–5.91, p=0.01), warm ischenia time (WMD: -6.96, 95% CI -7.30–-6.62, p <0.0001), conversion( OR: 0.34, 95%CI: 0.17 to 0.66, p=0.002) and intraoperative complication (OR: 0.52, 95% CI 0.28–0.97, p=0.04).ConclusionRPN could get better perioerative clinical outcomes than LPN for treatment of Complex Renal Tumors( with a RENALnephrometry score≥7).

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V10-11 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC RENAL TUMORS

The Journal of Urology ◽

10.1097/01.ju.0000557191.60001.64 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Amr Elbakry ◽

Alp Tuna Beksac ◽

Kennedy Okhawere* ◽

Bheesham Dayal ◽

Ketan Badani

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Robotic Partial Nephrectomy

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Tumor Volume and Tumor Crossing of the Axial Renal Midline as Preoperative Predictors of Reduced Estimated Glomerular Filtration Rate After Robotic Partial Nephrectomy

10.21203/rs.3.rs-538641/v1 ◽

2021 ◽

Author(s):

Haruyuki Ohsugi ◽

Kyojiro Akiyama ◽

Hisanori Taniguchi ◽

Masaaki Yanishi ◽

Motohiko Sugi ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Filtration Rate ◽

Tumor Volume ◽

Estimated Glomerular Filtration Rate ◽

Scoring Systems ◽

Renal Tumors ◽

Robotic Partial Nephrectomy

Abstract The ability of nephrometry scoring systems, including the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (R.E.N.A.L.), to predict loss of renal function after robotic partial nephrectomy (RPN) is still controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n=163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥20% from baseline to 6 months after RPN. Multivariate logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariate analyses indicated that tumor volume (cutoff value≥14.11 cm3, indicating a sphere with a diameter≥approximately 3 cm) and tumor crossing of the axial renal midline were independent factors for reduced eGFR (odds ratio [OR], 4.57; P=0.003 and OR, 3.21; P=0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC=0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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