scholarly journals Early vascular unclamping reduces warm ischaemia time in robot-assisted laparoscopic partial nephrectomy

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 108 ◽  
Author(s):  
Kevin Lah ◽  
Devang Desai ◽  
Charles Chabert ◽  
Christian Gericke ◽  
Troy Gianduzzo
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Positive Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Robot Assisted ◽  
Renal Masses ◽  
Warm Ischaemia ◽  
Ischaemia Time ◽  
Patient Series ◽  
Warm Ischaemia Time

Introduction: The aim of this study was to assess the outcomes of early vascular release in robot-assisted laparoscopic partial nephrectomy (RAPN) to reduce warm ischaemia time (WIT) and minimise renal dysfunction. RAPN is increasingly utilised in the management of small renal masses. To this end it is imperative that WIT is kept to a minimum to maintain renal function.Methods: RAPN was performed via a four-arm robotic transperitoneal approach. The renal artery and vein were individually clamped with robotic vascular bulldog clamps to allow cold scissor excision of the tumour. The cut surface was then sutured with one or two running 3-0 V-LocTM sutures, following which the vascular clamps were released. Specific bleeding vessels were then selectively oversewn and the collecting system repaired. Renorrhaphy was then completed using a running horizontal mattress 0-0 V-LocTM suture.Results: A total of 16 patients underwent RAPN with a median WIT of 15 minutes (range: 8-25), operative time 230 minutes (range: 180-280) and blood loss of 100 mL (range: 50-1000). There were no transfusions, secondary haemorrhages or urine leaks. There was one focal positive margin in a central 5.5 cm pT3a renal cell carcinomas (RCC). Long-term estimated glomerular filtration rate (eGFR) was not significantly different to pre-operative values.Conclusion: In this patient series, early vascular release effectively minimised WIT and maintained renal function without compromising perioperative safety.

The effects of warm ischaemia time on renal function after laparoscopic partial nephrectomy in patients with normal contralateral kidney

2011 ◽  
Vol 30 (2) ◽  
pp. 257-263 ◽  
Author(s):  
Francesco Porpiglia ◽  
Cristian Fiori ◽  
Riccardo Bertolo ◽  
Tiziana Angusti ◽  
Giorgina B. Piccoli ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Contralateral Kidney ◽  
Warm Ischaemia ◽  
Ischaemia Time ◽  
Warm Ischaemia Time

Reducing Warm Ischaemia Time During Laparoscopic Partial Nephrectomy: A Prospective Comparison of Two Renal Closure Techniques

2007 ◽  
Vol 52 (4) ◽  
pp. 1164-1169 ◽  
Author(s):  
Hervé Baumert ◽  
Andrew Ballaro ◽  
Nimish Shah ◽  
Dhouha Mansouri ◽  
Nauman Zafar ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Warm Ischaemia ◽  
Ischaemia Time ◽  
Prospective Comparison ◽  
Warm Ischaemia Time

A novel technique to limit renal warm ischaemia time during laparoscopic partial nephrectomy

2012 ◽  
Vol 110 (8) ◽  
pp. 1216-1219
Author(s):  
Nikhil Sapre ◽  
Niall M. Corcoran ◽  
Anthony J. Costello ◽  
Dinesh Agarwal
Keyword(s):  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Novel Technique ◽  
Warm Ischaemia ◽  
Ischaemia Time ◽  
Warm Ischaemia Time

scholarly journals A Hemostatic Technique in Robot-Assisted Laparoscopic Partial Nephrectomy and Its Impact on Renal Function

Cureus ◽  
2021 ◽  
Author(s):  
Deepak Raghavan ◽  
Mathisekaran Thangarasu ◽  
Sanjay Prakash J ◽  
Rajesh Paul ◽  
Nivash Selvaraj
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Robot Assisted

Clampless robot-assisted laparoscopic partial nephrectomy for large renal masses

2017 ◽  
Vol 16 (3) ◽  
pp. e2045-e2046
Author(s):  
A. Brassetti ◽  
G. Del Vecchio ◽  
P. Emiliozzi ◽  
M. Martini ◽  
A. Pansadoro ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Robot Assisted ◽  
Renal Masses

Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 402-402
Author(s):  
R. L. O'Malley ◽  
T. Kowalik ◽  
M. H. Hayn ◽  
T. B. Collins ◽  
H. L. Kim ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Cost Comparison ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

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