Comparison of open and robotic nephron sparing surgery: a single centre experience

Objective: To compare robotic partial nephrectomy (RAPN) with open partial nephrectomy (OPN) to assess efficacy and impact of learning curve. Methods: From 2010 to 2015 159 patients had a partial nephrectomy (82 OPN and 77 RAPN). All data were collected prospectively. We compared the demographics, peri and postoperative outcomes. Results: Mean age was 60 years in both groups; 59% of patients were men. Tumour size was larger in the open group (34 mm vs 30 mm; P<0.08), but RENAL nephrometry scores greater than 6 were comparable (over 60%). Mean ischaemic time was longer in the RAPN group (18 vs 13 minutes; P<0.04) but complication rates were similar. The RAPN cohort had a reduced estimated blood loss (100 ml vs 300 ml; P<0.01) and shorter median hospital stay (2 vs 5 days; P<0.01). Only two patients in each group were margin positive. The RAPN cohort demonstrated reduced estimated blood loss and a trend towards more complex tumours with increasing learning curve. Conclusion: RAPN is superior to OPN in terms of reduced hospital stay and estimated blood loss without compromising oncological outcomes. This service can be delivered safely and effectively in a low to medium volume cancer centre; these results are similar to published figures from high volume international centres.

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Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

Advances in Urology ◽

10.1155/2021/5569254 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Syed Ali Ehsanullah ◽

Abida Sultana ◽

Brian Kelly ◽

Charlotte Dunford ◽

Zaheer Shah

Keyword(s):

Renal Function ◽

Blood Loss ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Operative Time ◽

Tumour Size ◽

Open Approach ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

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Partial Nephrectomy A Comparison between Different Modalities

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v8i2.179 ◽

2021 ◽

Vol 8 (2) ◽

pp. 34-39

Author(s):

Ahmed Al Asker ◽

Abdulmalik Addar ◽

Mohammed Alghamdi ◽

Saud Alawad ◽

Mohammed Alharbi ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Tumor Size ◽

Robotic Partial Nephrectomy ◽

Chi Square ◽

Open Partial Nephrectomy ◽

Institutional Review

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

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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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Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

Canadian Urological Association Journal ◽

10.5489/cuaj.3197 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 859 ◽

Cited By ~ 12

Author(s):

Newaj Abdullah ◽

Deepansh Dalela ◽

Ravi Barod ◽

Jeff Larson ◽

Michael Johnson ◽

...

Keyword(s):

Regression Analysis ◽

Blood Loss ◽

Partial Nephrectomy ◽

Operative Time ◽

Independent Predictor ◽

Operating Time ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Obese Patients ◽

Estimated Blood Loss

Introduction: We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database. Methods: We identified 1836 patients who underwent RPN from five academic centres from 2006-2014. A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m2). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.Results: A total of 806 (44%) patients were obese with median BMI of 33.8kg/m2. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p<0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p<0.001), operative time (180 vs. 166 min, p<0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.Conclusion: In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss. However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT. Our results indicate that obesity alone should not preclude consideration for RPN.

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Early Single-Center Experience with Robotic Partial Nephrectomy Using the da Vinci Xi: Comparative Assessment with Conventional Open Partial Nephrectomy

Current Urology ◽

10.1159/000499300 ◽

2019 ◽

Vol 13 (1) ◽

pp. 13-18 ◽

Cited By ~ 1

Author(s):

Daisuke Motoyama ◽

Ryota Aki ◽

Yuto Matsushita ◽

Keita Tamura ◽

Toshiki Ito ◽

...

Keyword(s):

Partial Nephrectomy ◽

Da Vinci ◽

Operative Procedure ◽

Surgical Margin ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Da Vinci Xi ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss

Background: The objective of this study was to evaluate our experience with robot-assisted partial nephrectomy (RAPN) in comparison with conventional open partial nephrectomy (OPN). Patients and Methods: This study included 37 and 50 patients undergoing OPN and RAPN for small renal masses, respectively. A single surgeon performed RAPN for all 50 cases using the da Vinci Xi. Trifecta was defined as satisfying all of the following 3 criteria: ischemic time of ≤ 25 minutes, negative surgical margin and no major postoperative complications. Results: After adjusting patient variables by 1:1 propensity-score matching, 37 patients were included in each group, and no significant differences in major clinicopathological characteristics were noted between these 2 groups. RAPN was significantly superior to OPN with respect to operative time, estimated blood loss and postoperative length of hospital stay. The rate of trifecta achievement was significantly higher in the RAPN group than in the OPN group (91.9 vs. 62.2%). Furthermore, the operative procedure and R.E.N.A.L. nephrometry score were found to be independently associated with trifecta outcome by multivariate analysis of the entire cohort. Conclusions: Although this is our early experience with 50 initial cases, RAPN using the da Vinci Xi resulted in more favorable perioperative outcomes than OPN.

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

Surgical Innovation ◽

10.1177/1553350619856167 ◽

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.

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Cost comparison of robotic, laparoscopic, and open partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.394 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 394-394

Author(s):

Mehrdad Alemozaffar ◽

Steven Lee Chang ◽

Ravi Kacker ◽

Maryellen Sun ◽

William C DeWolf ◽

...

Keyword(s):

Sensitivity Analysis ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Hospital Costs ◽

Cost Comparison ◽

Renal Tumors ◽

Robotic Partial Nephrectomy ◽

Fixed Costs ◽

Average Hospital ◽

Open Partial Nephrectomy

394 Background: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are increasingly common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. The cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. Methods: Variable hospital costs including operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory charges were captured for 25 patients who underwent OPN, LPN, and RPN at our institution between 11/2008 -9/2010. Fixed costs of acquisition of a laparoscopic suite and a robotic system (including maintenance) were amortized over 7 years. We considered alternative scenarios through one-way and multi-way sensitivity analysis. Results: We found similar overall variable costs for OPN, LPN, and RPN. Sensitivity analysis demonstrated that RPN and LPN are more cost effective than OPN (excluding fixed costs) if the average hospital stay is < 2 days, or OR time less is than 204 and 196 mins, respectively. By including fixed costs of equipment, RPN and LPN are always more costly than OPN. Conclusions: There was no difference among variable hospital costs of OPN, LPN, and RPN. Minimizing OR time and hospital stay reduces RPN and LPN costs to levels comparable to OPN. Inclusion of fixed costs makes LPN and RPN more expensive than OPN, but increased utilization and efficiency can decrease cost per case. [Table: see text]

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Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.7.peds15187 ◽

2016 ◽

Vol 17 (3) ◽

pp. 361-370 ◽

Cited By ~ 38

Author(s):

Rowland H. Han ◽

Dennis C. Nguyen ◽

Brent S. Bruck ◽

Gary B. Skolnick ◽

Chester K. Yarbrough ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Csf Shunt ◽

Medical Complications ◽

Complication Rates ◽

Endoscopic Procedures ◽

Packed Red Blood Cells ◽

Estimated Blood Loss ◽

Csf Leakage

OBJECT The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors’ criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay. Complications were classified as either surgically or medically related. RESULTS In the nonsyndromic endoscopic group, the authors experienced 3 (2.1%) surgical and 5 (3.6%) medical complications. In the nonsyndromic open group, there were 2 (1.3%) surgical and 7 (4.5%) medical complications. Intraoperative durotomies occurred in 5 (3.6%) endoscopic and 12 (7.8%) open cases, were repaired primarily, and did not result in reoperations for CSF leakage. Similar complication rates were seen in syndromic cases. There was no death or permanent morbidity. Additionally, endoscopic procedures were associated with significantly decreased estimated blood loss, transfusions, procedure length, and length of hospital stay compared with open procedures. CONCLUSIONS Rates of intraoperative durotomies and surgical and medical complications were comparable between endoscopic and open techniques. This is the largest direct comparison to date between endoscopic and open interventions for synostosis, and the results are in agreement with previous series that endoscopic surgery confers distinct advantages over open surgery in appropriate patient populations.

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435 The learning curve for robotic partial nephrectomy in a high volume robotic surgery centre

European Urology Supplements ◽

10.1016/s1569-9056(14)60429-2 ◽

2014 ◽

Vol 13 (1) ◽

pp. e435

Author(s):

A. Kadirvelarasan ◽

O.D. Nehikhare ◽

P.D. Sturch ◽

A. Patel ◽

M. Brown ◽

...

Keyword(s):

Robotic Surgery ◽

Learning Curve ◽

Partial Nephrectomy ◽

High Volume ◽

Robotic Partial Nephrectomy

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Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series

Canadian Urological Association Journal ◽

10.5489/cuaj.7351 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dor Golomb ◽

Fernanda Gabrigna Berto ◽

Jennifer Bjazevic ◽

Jose A. Gomez ◽

Joseph L.K. Chin ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Functional Results ◽

Perioperative Outcomes ◽

Minimal Risk ◽

Complication Rates ◽

Control Series ◽

Estimated Blood Loss ◽

Simple Prostatectomy

Introduction: We aimed to assess the outcome of our series of simple prostatectomy using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches, at our institution. Methods: A retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. Results: From 2012–2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm3 (range 80–432 cm3). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in the robotic approach (p=0.04). Median estimated blood loss was 2300 ml (range 600–4000 ml) and 100 ml (range 50–400 ml) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p<0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). Conclusions: We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

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