scholarly journals Percutaneous hook wire assistance during laparoscopic excision of an intrarenal mass

2019 ◽  
Vol 101 (6) ◽  
pp. e136-e138
Author(s):  
C Kouriefs ◽  
F Georgiades ◽  
M Michaelides ◽  
K Ioannides ◽  
A Kouriefs ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Imaging ◽  
Perioperative Complications ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Fuhrman Grade ◽  
Estimated Blood Loss ◽  
Renal Tumours ◽  
Nephron Sparing ◽  
Laparoscopic Excision

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.

scholarly journals Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours

2017 ◽  
Vol 89 (2) ◽  
pp. 93 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Abdullah Hizir Yavuzsan ◽  
Yunus Colakoglu ◽  
Arda Atar ◽  
Selcuk Sahin ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Asa Score ◽  
Estimated Blood Loss ◽  
Renal Tumours ◽  
Significant Difference

Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

scholarly journals Percutaneous Microcoil Localization of a Small, Totally Endophytic Renal Mass for Nephron-Sparing Surgery: A Case Report and Literature Review

2021 ◽  
Author(s):  
Tianhao Su ◽  
Zhiyuan Zhang ◽  
Meishan Zhao ◽  
Gangyue Hao ◽  
Ye Tian ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Renal Mass ◽  
Perioperative Complications ◽  
Surgical Margin ◽  
Operation Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Nephron Sparing Surgery ◽  
Renal Surgery ◽  
Ct Guided ◽  
Nephron Sparing

Abstract Background: Small, totally endophytic renal masses present a technical challenge for surgical extirpation due to poor identifiability during surgery. The method for the precise localization of totally endophytic tumours before nephron-sparing surgery could be optimized. Case presentation: An asymptomatic 70-year-old male presented with a right-sided, 16-mm, totally endophytic renal mass on computed tomography (CT). CT-guided percutaneous microcoil localization was carried out prior to laparoscopy to provide a direction for partial nephrectomy. During the 25 minutes of the localization procedure, the patient underwent five local CT scans, and his cumulative effective radiation dosage was 5.1 mSv. The span between localization and the start of the operation was 15 hours. The laparoscopic operation time was 105 minutes, and the ischaemia time was 25 minutes. The postoperative recovery was smooth, and no perioperative complications occurred. Pathology showed the mass to be renal clear cell carcinoma, WHO/ISUP grade 2, with a 2-mm, clear surgical margin. The patient remained free of recurrence on follow-up for eleven months. To our knowledge, this application of microcoil implantation prior to laparoscopic partial nephrectomy for an intrarenal mass could be the first reported localized method applied in renal surgery. Conclusions: The percutaneous microcoil localization of endophytic renal tumours is potentially safe and effective prior to laparoscopic partial nephrectomy.

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).

Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery

2020 ◽  
pp. 039156032092172
Author(s):  
Stefano Manno ◽  
Lucio Dell’Atti ◽  
Antonio Cicione ◽  
Angelo Spasari
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Masses ◽  
Conversion To Open Surgery ◽  
Previous Abdominal Surgery ◽  
Estimated Blood Loss ◽  
Nephron Sparing

Objective: The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. Patients and methods: We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. Results: Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications ( p = 0.121). However, operative time ( p = 0.003) and length of stay ( p < 0.001) were greater in patients with versus those without previous open cholecystectomy. Conclusion: Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.

scholarly journals A systematic management algorithm for perioperative complications after robotic assisted partial nephrectomy

2019 ◽  
Vol 13 (11) ◽  
Author(s):  
James Ryan ◽  
Eoin MacCraith ◽  
Niall F. Davis ◽  
Liza McLornan
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Standard Procedure ◽  
Management Strategies ◽  
Ischemic Time ◽  
Robotic Assisted ◽  
Management Algorithm ◽  
Renal Tumours ◽  
Nephron Sparing ◽  
Robotic Assisted Partial Nephrectomy

Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal cell carcinoma (RCC). Since the first robotic-assisted partial nephrectomy (RAPN) was performed in 2004, NSS is being implemented with increasing frequency. RAPN will likely become the gold standard procedure for T1 RCC due to improved dexterity, enhanced visualization, shorter learning curve, quicker recovery time, and shortened warm ischemic time. Although RAPN appears to be the preferred treatment for select renal tumours, there are notable complications in up to 35% of cases. While complications associated with RAPN are well-described, there is a lack of literature describing appropriate management strategies. Herein, we review complications associated with RAPN and design an appropriate systematic management algorithm.

scholarly journals Surgical and Functional Outcomes on Omitting Cortical Renorrhaphy During Robot-Assisted Versus Laparoscopic Partial Nephrectomy: A Match-Paired Analysis

2022 ◽  
Author(s):  
Masashi Kubota ◽  
Toshinari Yamasaki ◽  
Shiori Murata ◽  
Yohei Abe ◽  
Yoichiro Tohi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Robot Assisted ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Estimated Blood Loss ◽  
Preservation Rate

Abstract Objectives To assess surgical and functional outcomes in comparison of cortical renorrhaphy omitting, robot-assisted partial nephrectomy (CRO-RAPN), and laparoscopic partial nephrectomy (CRO-LPN). Methods Between July 2012 and June 2020, patients with localized clinical T1-2 renal masses who underwent CRO-RAPN or CRO-LPN were reviewed. The outcomes of the CRO-RAPN and CRO-LPN groups were compared using propensity score matching. Trifecta was defined as negative surgical margin, less than 25 minutes of warm ischemic time, and no complications of Clavien-Dindo grade III or more until three months postoperatively. Preservation rate of the estimated glomerular filtration rate (eGFR) was evaluated at six months postoperatively. Results A total of 291 patients, including 210 patients who underwent CRO-RAPN and 81 patients who underwent CRO-LPN, were included, and matched pairs of 150 patients were analyzed. The CRO-RAPN group was associated with a significantly shorter warm ischemic time (13 min vs 20 min, P < 0.001), shorter total operation time (162 min vs 212 min, P < 0.001), less estimated blood loss (40 mL vs 119 mL, P = 0.002), lower incidence of overall complications (3% vs 16%, P = 0.001), higher preservation rate of eGFR at six months postoperatively (93% vs 89%, P = 0.003), and higher trifecta achievement rate (84% vs 64%, P = 0.004) than the CRO-LPN group. Conclusions CRO-RAPN contributes to a shorter warm ischemic time, less blood loss, fewer complications, and preservation of renal function and makes it feasible to achieve a higher rate of trifecta compared to CRO-LPN.

scholarly journals Off-Clamp Laparoscopic Partial Nephrectomy for a Fat-Poor Angiomyolipoma Arising from the Renal Capsule: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Koichi Kodama ◽  
Yasukazu Takase ◽  
Isamu Motoi ◽  
Katsuhiko Saito
Keyword(s):  
Partial Nephrectomy ◽  
Renal Damage ◽  
Left Kidney ◽  
Surgical Margin ◽  
Magnetic Resonance Images ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Capsule ◽  
Renal Masses ◽  
Nephron Sparing ◽  
Exophytic Tumor

Renal function can be significantly preserved after nephron-sparing surgery by decreasing the intraoperative ischemic duration or by performing off-clamp surgery. We report the case of a 56-year-old woman diagnosed with a minimal-fat angiomyolipoma arising from the renal capsule, which was successfully treated by retroperitoneoscopic partial nephrectomy without hilar clamping. Computed tomography revealed a 16 × 13 mm homogenous lenticular mass protruding from the lateral aspect of the left kidney. On both T1- and T2-weighted magnetic resonance images, the mass exhibited homogenous low-signal intensity and well-defined margins. Laparoscopic magnification indicated that the exophytic tumor was attached to the renal cortex by a small peduncle. The tumor was resected completely with negative surgical margin. The estimated glomerular filtration rate after surgery was nearly equal to that before surgery. Off-clamp laparoscopic partial nephrectomy is a feasible surgical option to prevent ischemic renal damage in select patients presenting with small, exophytic, and peripheral renal masses.

Nephron-Sparing Surgery: Laparoscopic Partial Nephrectomy

2008 ◽  
pp. 221-227
Author(s):  
Georges-Pascal Haber ◽  
Jose R. Colombo ◽  
Inderbir S. Gill
Keyword(s):  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Nephron Sparing Surgery ◽  
Nephron Sparing

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.

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