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

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.

scholarly journals Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

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.

scholarly journals COMPARISON OF THE USE OF PEDICLE SUBTRACTION OSTEOTOMY (PSO) IN PRIMARY AND REVISION OPERATIONS

2018 ◽  
Vol 25 (2) ◽  
pp. 5-12
Author(s):  
A. A. Panteleev ◽  
D. S. Gorbatyuk ◽  
M. L. Sazhnev ◽  
A. I. Kaz’min ◽  
V. S. Pereverzev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Postoperative Period ◽  
Lumbar Lordosis ◽  
Surgical Intervention ◽  
Pedicle Subtraction Osteotomy ◽  
Intraoperative Blood Loss ◽  
Revision Operations ◽  
Late Postoperative Period

Purpose of study: to evaluate clinical and roentgenologic results of the use of pedicle subtraction osteotomy (PSO) in primary and revision operations to determine the feasibility of radical spinal sagittal imbalance correction at primary surgical intervention.Patients and methods. Retrospective review of 42 patients (30 men and 12 women, mean age — 58.5 years) with rigid spinal deformities who underwent PSO was performed. Revision interventions (group R) were performed in 23 cases, primary (group P) — in 19 cases. The comparative analysis of spino-pelvic parameters and global spine balance, demographic indices, volume of intraoperative blood loss, duration of surgical intervention, complications in the late postoperative period and quality-of-life indices by SRS-22 and ODI scores was performed. Results. Minimum follow up period was 12 months. Osteotomy was more often performed at L3 level. No differences in the extent of fixation, duration of surgical intervention and degree of segmental correction were detected. The average blood loss was significantly lower in group P (p0.05). Analysis of the late postoperative period changes in roentgenologic parameters showed statistically significant differences for the lumbar lordosis index as well as inconsistency between the lumbar lordosis and pelvic index that were better in group P. Quality of life increased significantly in both groups with the only statistically significant difference in ODI that was better in group P. Serious complications were observed in 47.8 and 38.6% of cases in group R and group P, respectively (p0.05). Revision interventions were required in 26.1% of cases in group R and in 15.8% — in group P. Conclusion. In primary surgical interventions use of PSO technique enables to correct global spinal sagittal balance more effectively. Its use in primary interventions ensures lower volume of intraoperative blood loss as well as lower risk of pseudarthrosis formation and neurologic disorders development.

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.

Sternum resection and nephrectomy together in renal carcinoma with solitary sternal metastasis

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 146-148
Author(s):  
M. Franzini ◽  
G.L. Liera ◽  
P.P. Puviani ◽  
L. Mariani ◽  
B. Monica
Keyword(s):  
Quality Of Life ◽  
Survival Rate ◽  
Bone Metastasis ◽  
Renal Carcinoma ◽  
Renal Tumor ◽  
Renal Tumors ◽  
Aggressive Surgical Approach ◽  
Functional Problems

The role of surgery and adjuvant therapy in renal tumors with metastasis is considered purely palliative. However, in cases of solitary metastasis, an aggressive surgical approach is justified by results reported in current literature, in terms of survival rate and quality of life. In bone metastasis there are additional functional problems related to the site of the lesion and to the extend of the excision. In the reported case, the tumor became evident with a serious compressive cervical-mediastinal simptomatology, due to a solitary sternal metastasis, that was resected along with the primary renal tumor.

230: Prospective Trial Comparing Quality of Life between Laparoscopic Renal Cryoablation and Laparoscopic Partial Nephrectomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 76-77 ◽  
Author(s):  
Itay Vardi ◽  
Roberts Figenshau ◽  
Ramakrishna Venkatesh ◽  
Jaime Landman ◽  
Sam B. Bhayani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Partial Nephrectomy ◽  
Prospective Trial ◽  
Laparoscopic Partial Nephrectomy

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.

Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors: a modified R.E.N.A.L nephrometry score adjusted comparison

2018 ◽  
Vol 60 (2) ◽  
pp. 260-268 ◽  
Author(s):  
Vanessa Acosta Ruiz ◽  
Sam Ladjevardi ◽  
Einar Brekkan ◽  
Michael Häggman ◽  
Maria Lönnemark ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Partial Nephrectomy ◽  
Renal Tumor ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Efficacy Rate ◽  
Tumor Diameter ◽  
Technical Success ◽  
Nephrometry Score ◽  
Hospitalization Time

Background Comparable oncological outcomes have been seen after surgical nephrectomy and thermal ablation of renal tumors recently. However, periprocedural outcome needs to be assessed for aiding treatment decision. Purpose To compare efficacy rates and periprocedural outcome (technical success, session time, hospitalization time, and complications) after renal tumor treatment with laparoscopic partial nephrectomy (LPN) or radiofrequency ablation (RFA). Material and Methods The initial experience with 49 (treated with LPN) and 84 (treated with RFA) consecutive patients for a single renal tumor (diameter ≤ 5 cm, limited to the kidney) during 2007–2014 was evaluated. Patient and tumor characteristics, efficacy rates, and periprocedural outcome were collected retrospectively. The stratified Mantel Haenzel and Van Elteren tests, adjusted for tumor complexity (with the modified R.E.N.A.L nephrometry score [m-RNS]), were used to assess differences in treatment outcomes. Results Primary efficacy rate was 98% for LPN and 85.7% for RFA; secondary efficacy rate was 93.9% for LPN and 95.2% for RFA; and technical success rate was 87.8% for LPN and 100% for RFA. Median session (m-RNS adjusted P < 0.001; LPN 215 min, RFA 137 min) and median hospitalization time were longer after LPN (m-RNS adjusted P < 0.001; LPN 5 days, RFA 2 days). Side effects were uncommon (LPN 2%, RFA 4.8%). Complications were more frequent after LPN (m-RNS adjusted P < 0.001; LPN 42.9%, RFA 10.7%). Conclusion Both methods achieved equivalent secondary efficacy rates. RFA included several treatment sessions, but session and hospitalization times were shorter, and complications were less frequent than for LPN. The differences remained after adjustment for renal tumor complexity.

scholarly journals Analysis of Predictors of Adherent Perinephric fat and its Impact on Perioperative Outcomes in Laparoscopic Partial Nephrectomy: A Retrospective Case-control Study

2021 ◽  
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 2016 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 observed in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with 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, and warm ischemia time and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

scholarly journals Review of robot-assisted partial nephrectomy in modern practice

2015 ◽  
Vol 2 (2) ◽  
pp. 30-44 ◽  
Author(s):  
Aaron M Potretzke ◽  
John Weaver ◽  
Brian M Benway
Keyword(s):  
Surgical Technique ◽  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Standard Treatment ◽  
Renal Tumor ◽  
Renal Tumors ◽  
Robot Assisted

Partial nephrectomy (PN) is currently the standard treatment for T1 renal tumors. Minimally invasive PN offers decreased blood loss, shorter length of stay, rapid convalescence, and improved cosmesis. Due to the challenges inherent in laparoscopic partial nephrectomy, its dissemination has been stifled. Robot-assisted partial nephrectomy (RAPN) offers an intuitive platform to perform minimally invasive PN. It is one of the fastest growing robotic procedures among all surgical subspecialties. RAPN continues to improve upon the oncological and functional outcomes of renal tumor extirpative therapy. Herein, we describe the surgical technique, outcomes, and complications of RAPN. 

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