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 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 Comparison Robotic versus laparoscopic partial nephrectomy for Complex Renal Tumors (with a RENAL nephrometry score≥7): a meta-analysis

2020 ◽  
Author(s):  
Yu-Li Jiang ◽  
Xin Xiao ◽  
Fu-Sheng Peng ◽  
Tian-Li Shi ◽  
Xiao-Hui Huang ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operating Time ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Cochrane Central Register ◽  
Intraoperative Complication ◽  
Estimated Blood Loss

Abstract BackgroundTo compare the perioperative outcomes of Robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN). MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes RPN and LPN in patients with a RENALnephrometry score≥7. We used RevMan 5.2 to pool the data. ResultsSeven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: WMD: 34.49, 95% CI -75.16-144.14, p=0.54), hospital stay (WMD: -0.59 95% CI -1.24–0.06, p=0.07), operating time (WMD: -22.45, 95%CI: -35.06 to-9.85, ), postive surgical margin (OR: 0.85, 95% CI 0.65–1.11, p =0.23) and transfusion (OR: 0.72, 95% CI 0.48–1.08, p =0.11).between the two groups. RPN get better outcomes in postoperative renal function (WMD: 3.32, 95% CI 0.73–5.91, p=0.01), warm ischenia time (WMD: -6.96, 95% CI -7.30–-6.62, p <0.0001), conversion( OR: 0.34, 95%CI: 0.17 to 0.66, p=0.002) and intraoperative complication (OR: 0.52, 95% CI 0.28–0.97, p=0.04).ConclusionRPN could get better perioerative clinical outcomes than LPN for treatment of Complex Renal Tumors( with a RENALnephrometry score≥7).

scholarly journals Comparison of Robotic Versus Laparoscopic Partial Nephrectomy For Renal Tumors With A RENAL Nephrometry Score≥7: A System Review and Meta-Analysis

2021 ◽  
Author(s):  
Jin-Biao Zhou ◽  
Xin Xiao ◽  
Tian-Li Shi ◽  
Xiao-Hui Huang ◽  
Yu-Li Jiang
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Cochrane Central Register ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Abstract Background To compare the perioperative outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score≥7. Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score≥7. We used RevMan 5.2 to pool the data. Results Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p=0.54), hospital stay (WMD: -0.59; 95% CI: -1.24–0.06; p=0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p =0.23), major postoperative complications(OR: 0.90; 95% CI: 0.52–1.54; p=0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p =0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p=0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p=0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30–-6.62; p <0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p=0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p=0.04).Conclusions RPN showed better perioperative clinical outcomes than LPN for the treatment of complex renal tumors with a RENAL nephrometry score≥7.

scholarly journals Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

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).

scholarly journals Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Changwei Ji ◽  
Qun Lu ◽  
Wei Chen ◽  
Feifei Zhang ◽  
Hao Ji ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Laparoscopic Adrenalectomy ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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

2015 ◽  
Vol 9 (11-12) ◽  
pp. 859 ◽  
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

<p><strong>Introduction: </strong>We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database.<strong> </strong></p><p><strong>Methods: </strong>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/m<sup>2</sup>). 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.</p><p><strong>Results: </strong>A total of 806 (44%) patients were obese with median BMI of 33.8kg/m<sup>2</sup>. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p&lt;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&lt;0.001), operative time (180 vs. 166 min, p&lt;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.</p><p><strong>Conclusion: </strong>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.<strong></strong></p>

scholarly journals Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy

2015 ◽  
Vol 9 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael A. Moriarty ◽  
Kenneth G. Nepple ◽  
Chad R. Tracy ◽  
Michael E. Strigenz ◽  
Daniel K. Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Positive Margin ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Initial Experience ◽  
Robotic Assisted ◽  
Nephrometry Score ◽  
Significant Difference

Background: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. Methods: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). Results: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). Conclusion: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

scholarly journals Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

2020 ◽  
Author(s):  
Yanyang Jin ◽  
Mingshuai Wang ◽  
Feiya Yang ◽  
Nianzeng Xing
Keyword(s):  
Postoperative Complications ◽  
Partial Nephrectomy ◽  
Critical Role ◽  
Laparoscopic Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
High Grade ◽  
Ischemia Time ◽  
Imaging Results ◽  
Estimated Blood Loss ◽  
Clinical Records

Abstract Background: Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking.Methods: We retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC).Results: A total of 107 patients were ultimately evaluated. The median tumor size was 36.88 mm, and the median WIT, total operation time (OT) and estimated blood loss (EBL) were 18.97 min, 80 min, and 100 ml, respectively. Significant differences in WIT were identified among the complexity groups for each scoring system. Significant differences were identified between the OTs associated with the DAP and RENAL score complexity groups. The scores included in this study were significantly associated with the probability of having a WIT >20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.Conclusions: The scores included in this study were useful for preoperative assessment of retroperitoneal laparoscopic partial nephrectomy. No significant differences were observed among the scores in terms of their ability to predict prolonged hot ischemia time or high-grade postoperative complications. DAP is a good score in the retroperitoneal circumstance when its consistency is taken into account.

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