Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with large renal pelvic stones: a meta-analysis

2016 ◽  
Vol 64 (6) ◽  
pp. 1134-1142 ◽  
Author(s):  
Xuefang Rui ◽  
Haiyi Hu ◽  
Yanlan Yu ◽  
Shicheng Yu ◽  
Zhigen Zhang
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Publication Bias ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Renal Stones ◽  
Quality Analysis ◽  
Laparoscopic Pyelolithotomy

To compare percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP) for surgical management for large (>2 cm) renal stones. We searched MEDLINE, Cochrane, and EMBASE databases until March 11, 2015, using the following search terms: renalpelvic stone, percutaneous nephrolithotomy, laparoscopic pyelolithotomy. Randomized controlled and prospective and retrospective two-armed studies were included. Sensitivity analysis and assessment of the quality of the included studies and publication bias were performed. Nine studies were included in the study with a patient population of 622. The studies were homogeneous with respect to the primary end point of stone-free rate, but were heterogeneous with respect to operation time, length of hospital stay, and blood loss. A higher percentage of patients who received LP remained stone-free following surgery compared with patients who were treated with PCNL (p=0.001). However, the mean operation time was longer for patients with LP than for those treated with PCNL (p=0.002). There was no difference between procedures with regard to length of hospital stay or blood loss (p≥0.071). Sensitivity and quality analysis indicated that the data are reliable and the included studies are of good quality. No publication bias was observed. The study suggests that both procedures are effective and safe for removing large renal stones. However, LP may be more efficacious than PCNL in treating large kidney stones.

scholarly journals Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098313
Author(s):  
Tie Mao ◽  
Na Wei ◽  
Jing Yu ◽  
Yinghui Lu
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Complementary Treatment ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

scholarly journals Comparison of the clinical efficacy of sonography-guided percutaneous nephrolithotomy (PCNL) under local and general anesthesia

2019 ◽  
Vol 47 (9) ◽  
pp. 4143-4150
Author(s):  
Xunbao Wang ◽  
Qiongxiang Ye ◽  
Xinguo Liu ◽  
Jinjun Chen ◽  
Zhiyong Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Pain Scale ◽  
Visual Analogue Pain Scale ◽  
Visual Analogue Pain ◽  
The Mean

Objective This study aimed to compare the effect of percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia (PCNL-LIA) and general anesthesia (PCNL-GA) to treat upper urinary tract calculi on clinical application values. Methods Patients were randomly divided into the PCNL-LIA (16 patients) and PCNL-GA (20 patients) groups. Data on safety, cost, complications, rate of residual calculi, and prognosis were compared. Results The mean operation time in the PCNL-LIA group was less than that in PCNL-GA group (100±7.7 versus 120±9.0 minutes). The mean length of hospital stay in the PCNL-LIA group was shorter than that in the PCNL-GA group (6.9±0.5 versus 10.5±1.2 days). The rate of patients who required blood transfusion because of blood loss during or after surgery was less in the PCNL-LIN group than in the PCNL-GA group (13% versus 40%). The intervention rate in the PCNL-GA group was higher than that in the PCNL-LIA group. Visual analogue pain scale assessment showed that the PCNL-LIA group showed slightly more pain than the PCNL-GA group. Conclusion PCNL-LIA is safer, faster, and more convenient, and it also provides the benefits of a lower rate of blood loss and complications, lower cost, faster recovery, and shorter hospital stay compared with PCNL-GA.

Percutaneous nephrolithotomy vs. retrograde intrarenal surgery for renal stones larger than 2cm in patients with a solitary kidney: A systematic review and a meta-analysis

2019 ◽  
Author(s):  
Kehua Jiang ◽  
Guangheng Luo ◽  
Jianxing Hu ◽  
Jianguo Zhu ◽  
Fa Sun
Keyword(s):  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Solitary Kidney ◽  
Systematic Evaluation ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Retrograde Intrarenal Surgery

Abstract Background: The safety and feasibility of percutaneous nephrolithotomy (PCNL) compared with retrograde intrarenal surgery (RIRS) are debated. This systematic evaluation was performed to obtain comprehensive evidence with regard to the treatment outcomes of PCNL compared with RIRS for management of renal stones in patients with solitary kidney. Methods: A systematic search of Medline, Embase, Pubmed, and the Cochrane Library was performed to identify studies that compared PCNL with RIRS. Outcomes of interest included perioperative variables, complications, and stone-free rate (SFR). Results: 4 studies assessing PCNL vs. RIRS were included for meta-analysis. Although patients underwent PCNL have higher initial SFR than RIRS (OR: 3.72, 95% CI:2.38 to 5.83; P＜0.001), patients underwent RIRS have less intraoperative blood loss (dropped Hb: WMD= 3.49 g/L, 95% CI:2.83 to 4.15; P＜0.001), lower blood transfusion rates (OR= 5.31, 95% CI:1.36 to 20.68; P=0.02), and higher incidence rate of steinstrasse (OR:0.20, 95% CI:0.04 to 0.91; P=0.04). All the other calculated results including operation time (WMD: -9.87 minute, 95% CI:-30.11 to 10.37; P=0.34), final SFR (OR:1.65, 95% CI:0.80 to 3.42;P=0.18) and overall complications (OR:1.22, 95% CI:0.78 to 1.93; P=0.38) are similar between the two groups. Conclusions: Our results indicate that PCNL has higher initial SFR than RIRS in the treatment of renal stones in patients with a solitary kidney; the overall complications were comparable in both groups. However, RIRS, with less blood loss and transfusion rate, may be an alternative in selected patients.

scholarly journals Comparison of Micro-Percutaneous and Mini-Percutaneous Nephrolithotomy in the Treatment of Renal Stones: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoshuai Gao ◽  
Wei Wang ◽  
Liao Peng ◽  
Xingpeng Di ◽  
Kaiwen Xiao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Colic ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Operation Time ◽  
Renal Stones ◽  
Stent Insertion ◽  
Stay Time ◽  
Hemoglobin Drop

Background: To assess the efficacy and safety of micro-percutaneous nephrolithotomy (Microperc) and mini-percutaneous nephrolithotomy (Miniperc) in the treatment of moderately sized renal stones.Methods: Literature search of PubMed, Web of Science, and Embase was performed prior to January 2021. We used odds ratios (OR) and weighted mean difference (WMD) for dichotomous variables and continuous variables, respectively. Results were pooled using Review Manager version 5.3 software.Results: A total of six studies involving 291 Microperc and 328 Miniperc cases was included. The overall stone-free rate (SFR) of Microperc was 87.29% (254/291), while the SFR of Miniperc was 86.59% (284/328). Microperc was associated with lower hemoglobin drop (WMD: −0.98; P = 0.03) and higher renal colic requiring D-J stent insertion (OR: 3.49; P = 0.01). No significant differences existed between Microperc and Miniperc with respect to SFR (OR: 1.10; P = 0.69), urinary tract infection (OR: 0.38; P = 0.18), operative time (WMD: −5.76; P = 0.62), and hospital stay time (WMD: −1.04; P = 0.07).Conclusions: Our meta-analysis demonstrated that Microperc could produce an SFR that was comparable with that of Miniperc. Microperc was associated with lower hemoglobin drop, while Miniperc was associated with lower renal colic rates. In addition, the operation time and hospital stay time for both these procedures were similar.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

2020 ◽  
pp. 1-7
Author(s):  
Zhenhua Gu ◽  
Yucheng Yang ◽  
Rui Ding ◽  
Meili Wang ◽  
Jianming Pu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Retrograde Intrarenal Surgery ◽  
Alternative Approach ◽  
Significant Difference

<b><i>Background:</i></b> Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. <b><i>Objectives:</i></b> The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. <b><i>Methods:</i></b> A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. <b><i>Results:</i></b> Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, <i>p</i> = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, <i>p</i> = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, <i>p</i> = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, <i>p</i> &#x3c; 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, <i>p</i> = 0.04) when comparing RIRS with micro-PCNL. <b><i>Conclusions:</i></b> Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

scholarly journals Which factors affect the success of pediatric PCNL? Single center experience over 20 years

2020 ◽  
Vol 92 (4) ◽  
Author(s):  
Volkan Izol ◽  
Nihat Satar ◽  
Yıldırım Bayazit ◽  
Fatih Gokalp ◽  
Nebil Akdogan ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Pediatric Patients ◽  
Operation Time ◽  
Fluoroscopy Time ◽  
Postoperative Blood Transfusion ◽  
Group 2 ◽  
Group 1

Objective: We aimed to investigate the impact of surgeons’ experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes. Materials and methods: Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period. Results: Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994). Conclusions: The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.

scholarly journals Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 231
Author(s):  
Ponco Birowo ◽  
William Tendi ◽  
Indah S. Widyahening ◽  
Nur Rasyid ◽  
Widi Atmoko
Keyword(s):  
Hospital Stay ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Complication Rate ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Major Complication ◽  
Stone Free Rate ◽  
Major Complication Rate ◽  
Free Rate

Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 – 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 – 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon’s experience and clinical aspects of the patients.

scholarly journals Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy

2021 ◽  
Author(s):  
J. Kampers ◽  
E. Gerhardt ◽  
P. Sibbertsen ◽  
T. Flock ◽  
H. Hertel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Radical Hysterectomy ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Inclusion Criteria ◽  
Estimated Blood Loss

Abstract Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.

Sign in / Sign up

Export Citation Format

Share Document