“Off-Clamp, Non-renorrhaphy” Laparoscopic Partial Nephrectomy with Perirenal Fat and Gerota's Fascia Reapproximation: Initial Experience and Perioperative Outcomes

Background: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. Methods: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). Results: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). Conclusion: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

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V47 ‘Off-clamp, non-renorrhaphy’ laparoscopic partial nephrectomy with perirenal fat and Gerota's fascia reapproximation: Initial experience of a novel technique

European Urology Supplements ◽

10.1016/s1569-9056(13)61630-9 ◽

2013 ◽

Vol 12 (1) ◽

pp. eV47

Author(s):

T.S. Kim ◽

H.Y. Rhew ◽

J.H. Oh ◽

S.H. Kang ◽

S. Kim ◽

...

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Initial Experience ◽

Novel Technique ◽

Perirenal Fat

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Faculty Opinions recommendation of Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717248002.792502954 ◽

2012 ◽

Author(s):

Noor Buchholz ◽

Christian Bach

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Perioperative Outcomes

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Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

International braz j urol ◽

10.1590/s1677-55382012000100010 ◽

2012 ◽

Vol 38 (1) ◽

pp. 69-76 ◽

Cited By ~ 2

Author(s):

Carlo Camargo Passerotti ◽

Rodrigo Pessoa ◽

Jose Arnaldo Shiomi da Cruz ◽

Marcelo Takeo Okano ◽

Alberto Azoubel Antunes ◽

...

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Initial Experience ◽

Review Of The Literature ◽

Robotic Assisted

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Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02429-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Lu Fang ◽

Huan Li ◽

Tao Zhang ◽

Rui Liu ◽

Taotao Zhang ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Univariate Analysis ◽

Warm Ischemia ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Estimated Blood Loss ◽

Perinephric Fat

Abstract Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

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