Racial Comparison of Patients Undergoing Minimally Invasive Partial Nephrectomy for Renal Masses at a Large Volume Tertiary Center

Introduction: Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes. Methods: A three-step modified Delphi method was used to achieve expert agreement on the best practices for hemostasis in MIPN. Panelists were recruited from the Canadian Update on Surgical Procedures (CUSP) Urology Group, which represent all provinces, academic and community practices, and fellowship- and non-fellowship-trained surgeons. Thirty-two (round 1) and 46 (round 2) panellists participated in survey questionnaires, and 22 attended the in-person consensus meeting. Results: An initial literature search of 945 articles (230 abstracts) underwent screening and yielded 24 preliminary techniques. Through sequential survey assessment and in-person discussion, a total of 11 strategies were approved. These are temporally distributed prior to tumor resection (five principles), during tumor resection (two principles), and during renorrhaphy (four principles). Conclusions: Given the variability in tumor size, depth, location, and vascularity, coupled with limitations of laparoscopic equipment, achieving consistent hemostasis in MIPN may be challenging. Despite over two decades of MIPN experience, limited evidence exists to guide clinicians. Through a three-step Delphi method and rigorous iterative review with a panel of experts, we ascertained a guiding checklist of principles for newly beginning and practicing urologists to reference.

Download Full-text

Factors Associated With Receipt of Partial Nephrectomy or Minimally Invasive Surgery for Patients With Clinical T1a and T1b Renal Masses: Implications for Regionalization of Care

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2020.03.011 ◽

2020 ◽

Vol 18 (6) ◽

pp. e643-e650 ◽

Cited By ~ 2

Author(s):

Joshua Sterling ◽

Zorimar Rivera-Núñez ◽

Hiren V. Patel ◽

Nicholas J. Farber ◽

Sinae Kim ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Invasive Surgery ◽

Renal Masses ◽

Factors Associated ◽

Regionalization Of Care

Download Full-text

Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score‐matched analysis

International Journal of Urology ◽

10.1111/iju.14758 ◽

2021 ◽

Author(s):

Lorenzo Bianchi ◽

Francesco Chessa ◽

Pietro Piazza ◽

Amelio Ercolino ◽

Angelo Mottaran ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Percutaneous Ablation ◽

Renal Masses

Download Full-text

Cryoablation for Small Renal Masses

Advances in Urology ◽

10.1155/2008/479495 ◽

2008 ◽

Vol 2008 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

J. L. Dominguez-Escrig ◽

K. Sahadevan ◽

P. Johnson

Keyword(s):

Minimally Invasive ◽

Partial Nephrectomy ◽

Imaging Techniques ◽

Rapid Development ◽

High Intensity Focused Ultrasound ◽

Small Renal Masses ◽

Renal Masses ◽

Invasive Approach ◽

Open Partial Nephrectomy ◽

Ablative Techniques

Advances in imaging techniques (CT and MRI) and widespread use of imaging especially ultrasound scanning have resulted in a dramatic increase in the detection of small renal masses. While open partial nephrectomy is still the reference standard for the management of these small renal masses, its associated morbidity has encouraged clinicians to exploit the advancements in minimally invasive ablative techniques. The last decade has seen the rapid development of laparoscopic partial nephrectomy and novel ablative techniques such as, radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation (CA). In particular, CA for small renal masses has gained popularity as it combines nephron-sparing surgery with a minimally invasive approach. Studies with up to 5-year followup have shown an overall and cancer-specific 5-year survival of 82% and 100%, respectively. This manuscript will focus on the principles and clinical applications of cryoablation of small renal masses, with detailed review of relevant literature.

Download Full-text

Minimally Invasive Partial Nephrectomy and Ablative Procedures for Small Renal Masses

Renal Cancer ◽

10.1007/978-3-030-24378-4_14 ◽

2019 ◽

pp. 243-257

Author(s):

Shanta T. Shepherd ◽

Egor Parkhomenko ◽

David S. Wang

Keyword(s):

Minimally Invasive ◽

Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses ◽

Ablative Procedures

Download Full-text

Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.402 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 402-402

Author(s):

R. L. O'Malley ◽

T. Kowalik ◽

M. H. Hayn ◽

T. B. Collins ◽

H. L. Kim ◽

...

Keyword(s):

Minimally Invasive ◽

Operating Room ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Cost Comparison ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Robot Assisted ◽

Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

Download Full-text