Outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas

2021 ◽  
pp. 039156032110364
Author(s):  
Abdul Rouf Malik ◽  
Shayesta Ali ◽  
Venkatesh Kumar ◽  
Mahendra Sharma ◽  
Vijay Rawat ◽  
...  
Keyword(s):  
Blood Loss ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Renal Parenchyma ◽  
Nephron Sparing Surgery ◽  
Ct Urography ◽  
Ischemia Time ◽  
Complexity Score ◽  
Average Blood Loss ◽  
Nephron Sparing

Aim: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Materials and methods: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. Results: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4–6), five patients medium complexity score (i.e. 7–9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. Conclusion: Large AML’s are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.

scholarly journals Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique

2018 ◽  
Vol 46 (4) ◽  
pp. 1649-1656 ◽  
Author(s):  
Jianfei Ye ◽  
Shudong Zhang ◽  
Xiaojun Tian ◽  
Guoliang Wang ◽  
Lei Zhao ◽  
...  
Keyword(s):  
Operative Time ◽  
Suture Technique ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Nephron Sparing Surgery ◽  
Barbed Suture ◽  
Ischemia Time ◽  
Sutureless Technique ◽  
Nephron Sparing ◽  
The Mean

Objective Laparoscopic knot-tying and suturing are the most difficult steps in shortening the warm ischemia time and learning curve of laparoscopic nephron-sparing surgery. This study was performed to demonstrate the safety, oncological efficacy, and technical tips of sutureless retroperitoneal laparoscopic nephron-sparing surgery (RPNSS). Methods This retrospective study included 78 cases of RPNSS using a sutureless technique and 126 cases of RPNSS using a single-layer barbed self-retaining suture technique performed from December 2012 to December 2016. Results The mean warm ischemia time was significantly shorter in the sutureless technique group than in the barbed self-retaining suture technique group (6.8 vs. 21.1 minutes, respectively). There was no significant difference in the mean age, body mass index, R.E.N.A.L. Nephrometry score, operative time, maximal tumor diameter, intraparenchymal depth, blood loss, operative time, transfusion rate, complication rate, or postoperative hospital stay between the two groups. No open conversion was needed. No positive margins or local recurrence were observed during follow-up. Conclusions The sutureless technique was proven to be safe and oncologically effective and may allow novice laparoscopic surgeons to easily and quickly master RPNSS, a technically difficult procedure.

MP-04.04: Techniques for Reducing Renal Warm Ischemia Time for Laparoscopic Nephron-Sparing Surgery

Urology ◽  
2009 ◽  
Vol 74 (4) ◽  
pp. S58
Author(s):  
B. Fu ◽  
G. Wang ◽  
T. Sun ◽  
S. Cui ◽  
R. Cao ◽  
...  
Keyword(s):  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Nephron Sparing Surgery ◽  
Ischemia Time ◽  
Nephron Sparing

scholarly journals Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single-site Donor Nephrectomy

2020 ◽  
Author(s):  
Chung-Yu Lin ◽  
Ching-Chia Li ◽  
Hung-Lung Ke ◽  
Wen-Jeng Wu ◽  
Yii-Her Chou ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Operation Time ◽  
Warm Ischemia ◽  
Donor Nephrectomy ◽  
Warm Ischemia Time ◽  
Single Site ◽  
Perioperative Outcomes ◽  
Ischemia Time ◽  
Laparoendoscopic Single Site

Abstract Background: Laparoscopic living-donor nephrectomy is the standard technique at high-volume renal transplant centers. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a relatively novel minimally invasive surgery, which was differed to transperitoneal and retroperitoneal approaches. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN with regards to operative outcomes.Materials and Methods: Ten patients who underwent LESS-DN from 2017–2019 were enrolled at our center. The same surgeon performed all cases. The two approaches were compared retrospectively and evaluated for differences in perioperative outcomes, including operation time, console time, blood loss, graft warm ischemia time, postoperative pain, length of stay (LOS), wound size, postoperative pain, and renal function post LESS-DN at less than one year.Results: Total operating time (315 ± 82.69 vs. 191 ± 24.9 min, p = 0.016), console time (224 ± 74.15 vs. 110 ± 19.84 min, p = 0.016), and LOS (8.4 ± 1.82 vs. 4.8 ± 1.10 days, p = 0.013) were significantly longer in the transperitoneal group. The wound size (44 ± 3.81 vs. 68.2 ± 13.5 mm, p = 0.038) was significantly smaller in the transperitoneal group. There was no significant difference in other parameters, including blood loss, warm ischemia time, and postoperative pain from day one to day three.Conclusions: Retroperitoneal LESS-DN results in similar perioperative outcomes as transperitoneal LESS-DN without compromising donor safety, and while providing a faster operation time, console time, shorter LOS, and a trend toward a shorter warm ischemia time.

scholarly journals Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Carmine Sciorio ◽  
Pier Paolo Prontera ◽  
Salvatore Scuzzarella ◽  
Paolo Verze ◽  
Lorenzo Spirito ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Statistical Significance ◽  
Tumour Size ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Ischemia Time ◽  
Length Of Hospitalization

Objectives: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies.Methods: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemiacomplications [MIC] success rate) were considered. Results: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon’s experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). Conclusions: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients.

scholarly journals Preoperative scoring systems used in retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

2017 ◽  
Vol 12 (3) ◽  
pp. 141-147
Author(s):  
M.V. PIRVUT ◽  
◽  
N. GRIGORE ◽  
I. MIHAI ◽  
A. BENCHERKI ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
P Value ◽  
Ischemia Time ◽  
Contralateral Kidney ◽  
Risk Patients ◽  
The Mean

Introduction. P.A.D.U.A. (The preoperative aspects and dimensions used for anatomic), R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) and zonal NePhRO scoring were developed in an effort to predict the intraoperative (warm time ischemia, blood loss) and postoperative complications in patients undergoing partial nephrectomy, with an important role on surgical decision-making (2-4). Materials and methods. Between January 2014 and July 2017, 37 patients(p) underwent retroperitoneoscopic nephro-sparing surgery at our center for clinically localized renal tumor. All patients had a normal contralateral kidney. The selection of patients for nephro-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. A chart review was carried out, including age, sex, anatomic preoperative scoring system (P.A.D.U.A., R.E.N.A.L. nephrometry and zonal NePhRO), operative time (skin opening to skin closing), estimated blood loss (EBL), warm ischemia time (WIT), hospital stay. Results. The mean age of patients with partial nephrectomy was 54.3±9.1 years. Mean preoperative serum creatinine level for the patient group was 0.97±0.14 mg/dl. All patients had normal contralateral kidney. Average tumor diameter in this group was 3.6± 0.86 cm. When using P.A.D.U.A. score to predict warm time ischemia p value was of 0.001, even if the mean warm ischemia time is higher in medium risk patients than in high risk patients 24.3 min vs. 23.2 min. R.E.N.A.L. nephrometry score was able to predict the warm ischemia time according to the risk groups (17.6 vs. 23.9 vs. 31 min) with a p value under 0.001. Zonal NePhRO score was statistically correlated with total operative time, blood loss, warm ischemia and renal function decrease, all with a p value < 0.05. Conclusion. P.A.D.U.A. score, R.E.N.A.L. nephrometry score and Zonal NePhRO score have proved to be reliable preoperative tools in order to evaluate surgical complexity and to predict outcomes such as warm time ischemia, blood loss, postoperative estimated GFR and complications rate.

scholarly journals A Comparison of Laparoscopic Enucleation with Preoperative Selective Arterial Embolization (SAE) and Non-SAE for Renal Angiomyolipoma: A Meta-Analysis

2021 ◽  
Author(s):  
Jiaqi Kang ◽  
Yuxuan Song ◽  
Shangren Wang ◽  
Jia Tian ◽  
Li Liu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Web Of Science ◽  
Meta Analysis ◽  
Arterial Embolization ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Renal Angiomyolipoma ◽  
Ischemia Time ◽  
Selective Arterial Embolization ◽  
Laparoscopic Enucleation

Abstract Background: To compare the outcomes of laparoscopic enucleation with preoperative selective arterial embolization (SAE) and non-SAE for renal angiomyolipoma (RAML), we performed this systematic review and meta-analysis. Methods: We searched Web of Science, PubMed, EMBASE, the Cochrane Library, the Web of Science Core Collection, ClinicalTrials.gov, and China National Knowledge Infrastructure up to May 2019. Pooled relative ratio (RR) and standardized mean difference (SMD) with their 95% confidence intervals (CIs) were used to estimate the perioperative outcomes assessing the effectiveness and safety of laparoscopic enucleation with SAE and non-SAE.Results: A total of 4 studies were incorporated. The results showed that SAE group had a shorter operative time (SMD -2.15, 95% CI: -2.85 to -1.46, P < 0.001) , less blood loss (SMD -1.77, 95% CI: -2.06 to -1.47, P < 0.001), shorter warm ischemia time (SMD -2.57, 95% CI: -3.04 to -2.10, P < 0.001), and lower postoperative complication rate (RR 0.29, 95% CI: 0.08 to 0.98, P = 0.047), compared with the Non-SAE group. However, there was no significant difference in length of stay after operation (SMD -0.82, 95% CI: -3.26 to 1.63, P = 0.512), postoperative serum creatinine (SMD -0.59, 95% CI: -1.35 to 0.18, P =0.133), and GFR (SMD 0.59, 95% CI: -0.15 to 1.32, P =0.116) between the two groups. Sensitivity analysis showed that the results of our meta-analysis were robust, and deleting anyone study had no significant effect on the pooled results.Conclusions: Laparoscopic enucleation with preoperative SAE can shorten the operation time and warm ischemia time, decrease blood loss, preserve the renal function, and reduce the incidence of complications, which is a good option for the treatment of large RAMLs.

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