scholarly journals Clinical Study of Three-Dimensional Laparoscopic Partial Nephrectomy for the Treatment of Highly Complex Renal Tumors with RENAL Nephrometry Scores of ≥10 Points

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Maomao Li ◽  
Yu Ren ◽  
Guobin Weng
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Three Dimensional ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Intraoperative Blood Loss ◽  
Ischemic Time ◽  
Perioperative Complication

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.

scholarly journals Three-dimensional laparoscopic partial nephrectomy for renal hilar tumors: an empirical analysis of 290 patients

2020 ◽  
Author(s):  
Feiya Yang ◽  
Lianjie Mou ◽  
Nianzeng Xing
Keyword(s):  
Partial Nephrectomy ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Intraoperative Ultrasound ◽  
Operation Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Significant Difference ◽  
Group A

Abstract Objective To explore the feasibility of laparoscopic partial nephrectomy(LPN) in the treatment of renal hilar tumors. Methods Clinical data of 290 patients undergoing laparoscopic partial nephrectomy from January 2013 to August 2019 were retrospectively analyzed, including 27 patients with renal hilar tumors and 263 patients with non-hilar renal tumors. Perioperative data and follow-up results were compared between the two groups. Results Tumor size in Group A is smaller(2.97±0.88 vs 3.55±1.46,p<0.05), R.E.N.A.L. nephrometry score of Group A is higher(8.4±1.3 vs 6.5±1.7,p<0.01).The operation time, WIT and intraoperative blood loss in the Group A were slightly higher, but with no statistical difference (p>0.05). There was no significant difference between the two groups in intraoperative ultrasound rate, collection system repair rate, drainage time,postoperative hospital stay, and eGFR changes (p>0.05).The median follow-up period was 40 months. One patient with postoperative pathologic report of angiomyolipoma was found tumor recurrence and was currently undergoing regular reexamination. Conclusion Three-dimensional laparoscopic partial nephrectomy for renal hilar tumors is safe and feasible after detailed preoperative evaluation of the tumor and selection of appropriate surgical strategies.

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

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

scholarly journals Tumor volume and tumor crossing of the axial renal midline predict renal function after robotic partial nephrectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Haruyuki Ohsugi ◽  
Kyojiro Akiyama ◽  
Hisanori Taniguchi ◽  
Masaaki Yanishi ◽  
Motohiko Sugi ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumor Volume ◽  
Characteristic Curve ◽  
Three Dimensional ◽  
Scoring Systems ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Perioperative Morbidity

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.

scholarly journals Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

2019 ◽  
Author(s):  
Xiaorong Wu ◽  
Chen Jiang ◽  
Guangyu Wu ◽  
Chao Shen ◽  
Qibo Fu ◽  
...  
Keyword(s):  
Renal Function ◽  
3D Reconstruction ◽  
Partial Nephrectomy ◽  
Three Dimensional ◽  
Renal Tumors ◽  
Feeding Artery ◽  
Zero Ischemia ◽  
Computer Tomography Angiography ◽  
Conventional Computer

Abstract Background: Advances in the three dimensional (3D) reconstruction and printing technology have fueled a rapidly growing interest in its applications in the field of urology. To our knowledge, the experience on the use of 3D reconstruction to facilitate zero-ischemia partial nephrectomy (PN) remains sparse and the role of 3D reconstruction is still needed to be defined. This study aimed to assess the role of three-dimensional (3D) reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiology findings were directly correlated with intraoperative surgical findings at laparoscopy. Demographics, perioperative characteristics and renal function were compared between groups. Results: CTA and 3D reconstruction were successfully performed without any related complications. All the procedures were performed successfully without conversion to main renal artery clamping. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05). 3D reconstruction group resulted in more accurate dissection of tumor artery (91.7%) as compared to conventional CTA (84.2%). There were no statistical differences in the baseline characteristics and renal function outcomes between two groups. Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation that may facilitate tumor resection during zero-ischemia LPN for renal tumors.

scholarly journals Three-dimensional printing for laparoscopic partial nephrectomy in patients with renal tumors

2019 ◽  
Vol 47 (9) ◽  
pp. 4324-4332 ◽  
Author(s):  
Gang Fan ◽  
Yanbin Meng ◽  
Shuai Zhu ◽  
Mingji Ye ◽  
Mingfeng Li ◽  
...  
Keyword(s):  
Blood Loss ◽  
Physical Model ◽  
Partial Nephrectomy ◽  
Three Dimensional ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Postoperative Blood Loss ◽  
Complication Rates ◽  
Three Dimensional Printing ◽  
Dimensional Printing

Objectives To explore the efficacy of three-dimensional printing physical model-assisted laparoscopic partial nephrectomy (3D-LPN) in patients with renal tumors. Methods We retrospectively assessed all patients who underwent LPN with or without 3D-printed physical model assistance from January 2016 to February 2018 at our institution. The demographic characteristics, operative findings, and clinical outcomes from the procedure were collected and analyzed. Results Sixty-nine patients underwent 3D-LPN and 58 underwent traditional LPN. The groups showed no differences in demographics, RENAL score, surgical approach, operative time, estimated intra-/postoperative blood loss, increased creatinine level, or complications. In the 3D-LPN group, warm ischemia time was shorter, whereas surgery waiting time was longer, compared with those parameters in the LPN group. Subgroup analysis indicated that for patients with RENAL score ≥8, the 3D-LPN group had significantly shorter warm ischemic time and less intraoperative blood loss than the traditional LPN group. Intra- and postoperative hospital complication rates were similar for 3D-LPN and traditional LPN groups (8.7% vs. 13.7%). Conclusions 3D printing provides an additional tool to assist with LPN. Use of a 3D model can assist in planning and performance of LPN in patients with RENAL score ≥8.

Development of nomogram to predict renal function outcome after laparoscopic partial nephrectomy: Japanese multi-institutional study including 915 patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15576-e15576
Author(s):  
Hideo Saito ◽  
Tadashi Matsuda ◽  
Kazunari Tanabe ◽  
Akihiro Kawauchi ◽  
Toshiro Terachi ◽  
...  
Keyword(s):  
Renal Function ◽  
Risk Factor ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Clinical Decision Making ◽  
De Novo ◽  
Japanese Patients ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Multivariate Logistic Regression Model

e15576 Background: Chronic kidney disease (CKD) is an independent risk factor for death from all causes. However Japanese individuals tend to have a different lifestyle, including diet and other behavior, than Western individuals and in Japanese some studies show a lower prevalence of obesity and atherosclerosis. To evaluate longitudinal change in renal function after laparoscopic partial nephrectomy (LPN) with renal tumors, we investigate predict risk factor which affect a decrement of renal function. Methods: A nation-wide survey was performed by the LPN study group under the support of Japanese Society of Endourology. Of the 228 insitutes, 63 (28%) insitutes had more than 10 LPN experience. Between Dec 1998 and Dec 2008, 1,375 Japanese patients underwent LPN. Patients with solitary kidney, preoperative eGFR below 45ml/min/1.73m2 were excluded from analysis. Thus, 915 patients were enrolled in this study. Multivariate analysis was performed examining factors associated with the development of de novo eGFR<45 and 60. Results: Patient charcteristics: median age 60 yrs (IQR 50-69), male/female 672/243, hypertension 307 (34%), diabetes mellitus 149 (16%), hyperlipidemia 115 (12%), median BMI 23.8 (IQR 22-26), mean ASA score 1.6±0.6., median tumor size was 2.1 cm (IQR 1.7–2.8), median preoperative eGFR 74 (IQR 64-86). Pedicle clamping was done in 674 cases (73%). The 1-year probability of new onset of an eGFR less than 60 and 45 was 20.0% and 5.6%, respectively. A multivariate model revealed that age, tumor size and preoperative eGFR are independently predictive of de novo eGFR<45. Nomogram was developed based on a multivariate logistic regression model. The area under the ROC curve for de novo eGFR<45 was 0.930. Conclusions: Compared with radical nephrectomy, LPN could preserve renal function. But, even in Japanese, patients undergoing LPN had high comorbidity and 20% of patients developed de novo eGFR<60. We developed novel predictive models for CKD after LPN. This nomogram provides important implications in clinical decision making regarding treatment options or follow-up strategy.

scholarly journals Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

2020 ◽  
Vol 9 (11) ◽  
pp. 3658
Author(s):  
Ching-Chia Li ◽  
Tsu-Ming Chien ◽  
Shu-Pin Huang ◽  
Hsin-Chih Yeh ◽  
Hsiang-Ying Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Renal Cancer ◽  
Operation Time ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Single Site ◽  
Renal Tumors ◽  
Ischemic Time ◽  
Intracorporeal Suturing ◽  
Ischemia Time

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.

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