Uninterrupted suturing of renal parenchyma in laparoscopic partial nephrectomy decreases renal ischemic time and intraoperative blood loss

Aims. To examine the safety and feasibility of three-dimensional (3-D) laparoscopic partial nephrectomy for clinically complex renal tumors. Materials and Methods. We retrospectively evaluated 76 patients who underwent a 3-D ( n = 42 ; age, 54.6 ± 12.2 years) or two-dimensional (2-D) laparoscopic partial nephrectomy ( n = 34 ; age, 54.8 ± 13.2 years) for renal tumors with RENAL nephrectomy scores of ≥10 points from the same surgical group between January 2017 and April 2020 in Ningbo Urology and Nephrology Hospital. Mean tumor diameter, operation time, warm ischemic time, amount of intraoperative blood loss, postoperative hospitalization time, hospitalization cost, perioperative complication rate, and renal function were compared. Results. The operation time ( 154.6 ± 45.1 min) and warm ischemic time ( 22.5 ± 6.8 min) in the 3-D laparoscopic group were significantly lower than those in the 2-D laparoscopic group ( 193.0 ± 59.2 min, p = 0.001 and 28.7 ± 7.8 min, p = 0.0002 , respectively). No significant differences in amount of intraoperative blood loss ( p = 0.642 ), length of postoperative hospital stay ( p = 0.541 ), perioperative complication rate ( p = 0.860 ), total hospital cost ( p = 0.641 ), and renal function changes including estimated glomerular filtration rate and serum creatinine ( p > 0.05 ) were found between the two groups. Conclusion. Our preliminary experience showed that the 3-D laparoscopic imaging system significantly shortened the operation and renal ischemic times, which are more conducive to partial resection of highly complex renal tumors.

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Clinical outcomes and effect on intraoperative blood loss and postoperative pain of patients undergoing retroperitoneal laparoscopic partial nephrectomy for complex renal tumors

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02397-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yansong Guo ◽

Qian Xu ◽

Baochun Chen ◽

Lifeng Liu ◽

Yuanyuan Wang ◽

...

Keyword(s):

Quality Of Life ◽

Stress Response ◽

Postoperative Pain ◽

Blood Loss ◽

Partial Nephrectomy ◽

Renal Tumor ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Intraoperative Blood Loss

Abstract Objective To explore the clinical outcomes and effect on intraoperative blood loss and postoperative pain of patients undergoing the retroperitoneal laparoscopic partial nephrectomy (RLPN) for complex renal tumors. Methods Fifty patients with complex renal tumor admitted to our hospital from February 2017 to February 2019 were selected as the research object and divided into the RLPN group (given the retroperitoneal laparoscopic partial nephrectomy, n = 24) and the OPN group (given the open partial nephrectomy, n = 26) by number table method to compare their various perioperative indicators and serum stress response and analyze the clinical effect of different surgical methods on the complex renal tumor. Results The clinical information of patients in both groups were not significantly different (P > 0.05); in addition to the operative time, the intraoperative blood loss, hospital stay, warm ischemia time, and numerical rating scale (NRS) scores of the RLPN group were clearly lower than those of the OPN group (P < 0.05); after treatment, patients in the RLPN group obtained significantly lower white blood cell (WBC) count, cortisol, and c-reactive protein (CRP) levels than the OPN group (P < 0.05); the renal glomerular filtration rate (GFR) of the affected side, quality of life scores, and 3-year overall survival rate of treated patients in the RLPN group were obviously higher than those in the OPN group (P < 0.05); and patients in the RPLN group had significantly lower incidence rate (P < 0.05). Conclusion Compared with OPN, RLPN is more worthy of promotion and application, because it has better treatment outcomes, significantly reduces intraoperative blood loss, alleviates the body stress response and postoperative pain, and improves the quality of life.

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Surgical and Functional Outcomes on Omitting Cortical Renorrhaphy During Robot-Assisted Versus Laparoscopic Partial Nephrectomy: A Match-Paired Analysis

10.21203/rs.3.rs-1191585/v1 ◽

2022 ◽

Author(s):

Masashi Kubota ◽

Toshinari Yamasaki ◽

Shiori Murata ◽

Yohei Abe ◽

Yoichiro Tohi ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Surgical Margin ◽

Laparoscopic Partial Nephrectomy ◽

Robot Assisted ◽

Ischemic Time ◽

Warm Ischemic Time ◽

Estimated Blood Loss ◽

Preservation Rate

Abstract Objectives To assess surgical and functional outcomes in comparison of cortical renorrhaphy omitting, robot-assisted partial nephrectomy (CRO-RAPN), and laparoscopic partial nephrectomy (CRO-LPN). Methods Between July 2012 and June 2020, patients with localized clinical T1-2 renal masses who underwent CRO-RAPN or CRO-LPN were reviewed. The outcomes of the CRO-RAPN and CRO-LPN groups were compared using propensity score matching. Trifecta was defined as negative surgical margin, less than 25 minutes of warm ischemic time, and no complications of Clavien-Dindo grade III or more until three months postoperatively. Preservation rate of the estimated glomerular filtration rate (eGFR) was evaluated at six months postoperatively. Results A total of 291 patients, including 210 patients who underwent CRO-RAPN and 81 patients who underwent CRO-LPN, were included, and matched pairs of 150 patients were analyzed. The CRO-RAPN group was associated with a significantly shorter warm ischemic time (13 min vs 20 min, P < 0.001), shorter total operation time (162 min vs 212 min, P < 0.001), less estimated blood loss (40 mL vs 119 mL, P = 0.002), lower incidence of overall complications (3% vs 16%, P = 0.001), higher preservation rate of eGFR at six months postoperatively (93% vs 89%, P = 0.003), and higher trifecta achievement rate (84% vs 64%, P = 0.004) than the CRO-LPN group. Conclusions CRO-RAPN contributes to a shorter warm ischemic time, less blood loss, fewer complications, and preservation of renal function and makes it feasible to achieve a higher rate of trifecta compared to CRO-LPN.

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875: The Effect of Warm Ischemic Time on the Ipsilateral Renal Function after Laparoscopic Partial Nephrectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)33111-2 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 282-283

Author(s):

Shigeta Masanobu ◽

Koji Mita ◽

Tsuguru Usui ◽

Kazushi Marukawa ◽

Toshihiro Tachikake

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Ischemic Time ◽

Warm Ischemic Time

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V1918: Laparoscopic Partial Nephrectomy with Clamping of the Renal Parenchyma

The Journal of Urology ◽

10.1016/s0022-5347(18)32228-6 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 637-637

Author(s):

Andrea Manunta ◽

Francois Guille ◽

Karim Bensalah ◽

Sebastien Vincendeau ◽

Jean Jacques Patard

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Renal Parenchyma

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Re: Günter Janetschek. Laparoscopic Partial Nephrectomy for RCC: How Can We Avoid Ischemic Damage of the Renal Parenchyma? Eur Urol 2007;52:1303–5

European Urology ◽

10.1016/j.eururo.2008.01.030 ◽

2008 ◽

Vol 53 (6) ◽

pp. 1302-1303

Author(s):

Giuseppe Simone ◽

Salvatore Guaglianone ◽

Michele Gallucci

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Renal Parenchyma ◽

Ischemic Damage

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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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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