scholarly journals Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

2020 ◽  
Vol 8 (6) ◽  
pp. 161-166
Author(s):  
Krishnendu Biswas ◽  
Rohan S Batra ◽  
Abhishek G Singh ◽  
Arvind P Ganpule ◽  
Ravindra B Sabnis ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Robotic Partial Nephrectomy ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Significant Difference ◽  
One Year

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

scholarly journals Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

2017 ◽  
Vol 11 (7) ◽  
pp. E261-5 ◽  
Author(s):  
Jeffrey Campbell ◽  
Garson Chan ◽  
Patrick P. Luke
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Standard Technique ◽  
Bleeding Risk ◽  
Early Postoperative Period ◽  
Control Group ◽  
Ischemic Time ◽  
Significant Difference

Introduction: Intraoperative warm ischemic time (WIT), associated with hilar clamping during partial nephrectomy (PN), is an established modifiable risk factor for renal dysfunction. We assessed early clamp release (ECR) as a strategy to reduce WIT and assess its impact on renal function and bleeding.Methods: We retrospectively assessed patients who underwent minimally invasive PN by a single surgeon at our centre since December 2011. Comparing the standard technique to an ECR modification, WIT, complications, change in estimated glomerular filtration rate (eGFR), and change in differential function as demonstrated by MAG-3 nuclear renography were assessed. Followup blood work and renograms were performed at 6‒12 weeks postoperatively and compared to baseline in 70 patients (35 ECR: 35 control).Results: The ECR and control groups were similar in age, sex, and tumour size, with only patient weight being higher in the ECR group (91.6 vs. 81.6 kg; p<0.05). WIT was significantly lower in ECR group compared to control (18.8 vs. 31.5 minutes; p<0.05). Although there was no significant difference in change from baseline eGFR in the early postoperative period (Day 3) or in followup (6‒12 weeks), the control group had a significantly greater loss of ipsilateral renal function from baseline compared to the ECR group (9 vs. 4% change; p<0.05). Blood loss and complication rate weresimilar between groups.Conclusions: The ECR technique offers a safe, reproducible alternative that reduces WIT during laparoscopic PN. ECR demonstrates a reduction in overall ipsilateral renal dysfunction, without increasingcomplication or intraoperative bleeding risk.

scholarly journals Ipsilateral renal function preservation following minimally invasive partial nephrectomy: The effect of tumour characteristics and warm ischemic time

2017 ◽  
Vol 11 (10) ◽  
pp. 344-9 ◽  
Author(s):  
Ernest Chan ◽  
Shawna L. Boyle ◽  
Jeffrey Campbell ◽  
Patrick P.W. Luke
Keyword(s):  
Renal Function ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Renal Parenchyma ◽  
Renal Masses ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Function Preservation ◽  
Collecting System

Introduction: The relative impact of preoperative and perioperative variables on renal function following partial nephrectomy (PN) is controversial. To further investigate, we assess the effects of tumour complexity, warm ischemic time (WIT), and volume of resected renal parenchyma on ipsilateral renal function (IRF) outcomes following minimally invasive PN.Methods: Of patients who underwent laparoscopic or roboticassisted PN between 2002 and 2011 at our institution, 99 met our inclusion criteria. The effects of preoperative tumour complexity (using RENAL nephrometry score), perioperative WIT, and pathological tumour volumes on ipsilateral renal function preservation (%IRF) were analyzed. %IRF was defined as the proportion of postoperative to preoperative ipsilateral renal function calculated using MAG3 nuclear renography.Results: Increasing RENAL nephrometry score (RNS) and WIT were independently predictive of inferior %IRF at 6‒12-week postoperative followup in univariate and multivariate analyses. Of RNS properties, masses that were endophytic, near the collecting system, or central in location were associated with inferior %IRF, with nearness to collecting system as the strongest predictor; however, RNS was no longer predictive of %IRF in cases requiring more than 30 minutes of WIT.Conclusions: In renal masses amenable to resection by minimally invasive PN, longer WIT was the most important predictor of inferior %IRF. Although increasing RNS score influenced %IRF, the overall clinical significance of RNS is limited and should not influence operative decision-making in efforts to preserve renal function. Furthermore, small volumes of renal parenchyma can be safely resected without impairment of long-term IRF.

scholarly journals Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

2013 ◽  
Vol 7 (9-10) ◽  
pp. 348 ◽  
Author(s):  
Guillaume Ploussard ◽  
Richard Haddad ◽  
Evan Kovac ◽  
Patrick Richard ◽  
Maurice Anidjar ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Admission Rate ◽  
Complication Rates ◽  
Robot Assisted ◽  
Nephrometry Score ◽  
Surgeon Experience ◽  
The Mean

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program.Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months.Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure.Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure. 

875: The Effect of Warm Ischemic Time on the Ipsilateral Renal Function after Laparoscopic Partial Nephrectomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 282-283
Author(s):  
Shigeta Masanobu ◽  
Koji Mita ◽  
Tsuguru Usui ◽  
Kazushi Marukawa ◽  
Toshihiro Tachikake
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Ischemic Time ◽  
Warm Ischemic Time

What is the most important predictor of renal function after opened and robotic partial nephrectomy? A propensity score matched study.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 701-701
Author(s):  
Ngoc Ha Nguyen ◽  
Jae Young Joung ◽  
Sangchul Lee ◽  
Hakmin Lee ◽  
Young Dong Yu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Propensity Score ◽  
Postoperative Complication ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Ckd Progression ◽  
Ischemic Time ◽  
Major Postoperative Complication ◽  
Estimated Blood Loss

701 Background: This study was designed to investigate the parameters that predict the short term and long term renal function after opened partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RPN). Methods: Medical records of 896 patients who underwent OPN and RPN between Feb 2004 to Apr 2017 at our institution were retrospectively reviewed. The propensity scores matching between of OPN and RPN group were performed with a ratio of 1:1. Postoperative outcomes were compared and multivariate logistic regression was performed to identify the parameters influencing acute kidney injury (AKI) and chronic kidney disease (CKD) progression. Results: No significant differences of preoperative characteristics were observed between two study groups after propensity score matching. RPN was significantly associated with longer warm ischemic time (WIT) (p < 0.001); yet, estimated blood loss (EBL), positive surgical margin (PSM) rate, major postoperative complication and CKD progression were significantly lower in RPN group (p values were < 0.001; 0.033; < 0.001; < 0.001 and 0.005 respectively). Multivariate analysis exhibited RPN is more favorable than OPN in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate (eGFR) were significantly associated with greater risk of AKI (OR = 1.036; 95% CI of OR 1.021-1.052; p < 0.001), but reduced risk of CKD progression (OR = 0.975; 95% CI of OR 0.955-0.994; p = 0.011). Other independent predictors of CKD progression included WIT (p = 0.025), age (p = 0.035), higher BMI (0.041) and diabetes mellitus history (p = 0.035). Conclusions: Age, BMI, diabetes mellitus history, baseline eGFR and WIT were the independent predictors of CKD progression after PN. RPN is more favorable than OPN for reducing EBL, PSM, major postoperative complication and renal function preservation.

scholarly journals Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy: Oncologic and Functional Outcomes in 49 Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Kalen Rimar ◽  
Aziz Khambati ◽  
Barry B. McGuire ◽  
David A. Rebuck ◽  
Kent T. Perry ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Comparison Group ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Transfusion Rate ◽  
Urine Leak ◽  
Significant Difference

Introduction and Objectives. Robotic partial nephrectomy with peritumoral radiofrequency ablation (RFA-RPN) is a novel clampless technique. We describe oncologic and functional outcomes in a prospective cohort. Methods. From May, 2007, to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RFA-RPN. During this period, only the RFA-RPN technique was utilized for all cases of partial nephrectomy. Pre- and postoperative data were analyzed and compared to 36 consecutive patients who underwent LPN. Results. In total, 49 tumors were treated in the RFA-RPN group and 36 tumors in the comparison group. Mean operative time was longer in the RFA-RPN group (370 min versus 293 min, p<0.001). There were no significant differences in mean EBL (231 cc versus 250 cc, p=0.42), transfusion rate (8.2% versus 11.1%, p=0.7), or hospital stay (3.9 versus 4.4 days, p=0.2). Two patients in the RFA-RPN (4.1%) and 1 (2.7%) patient in the comparison group had a positive surgical margin (p=0.75). 17 (34.7%) patients had a postoperative urine leak in the RFA-RPN group versus 2 (5.6%) patients in the comparison group (p=0.001). Mean follow-up was 54 months versus 68.4 months in the comparison group. There was no significant difference between the two groups regarding change in GFR (p=0.67). There were 3 recurrences (6.1%) in the RFA-RPN group and 0 recurrences in the RPN group (p=0.23). There were 3 deaths (6.1%) in the RFA-RPN group (one cancer specific) and 4 deaths (11.1%) in the RPN group (non-cancer specific) over the follow-up period (p=0.44). Conclusions. Our data suggests that this technique is associated with a similar degree of renal preservation but higher rates of postoperative urine leak and possibly higher rates of recurrence.

Tumor location does not impact return of renal function following partial nephrectomy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14511-14511
Author(s):  
J. Pettus ◽  
D. Sharp ◽  
Y. Ofer ◽  
A. Bach ◽  
P. Russo
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Tumor Location ◽  
Early Postoperative Period ◽  
Renal Sinus ◽  
Ischemic Time ◽  
Disease Study ◽  
The Impact

14511 Background: To study the impact of tumor location on the glomerular filtration rate (GFR) changes following partial nephrectomy. Methods: We reviewed our institutional database to identify patients who underwent partial nephrectomy between 1/1995 and 7/2005. Preoperative CT and/or MRI studies were reviewed to characterize tumors as either central or peripheral. Central tumors were defined as those involving the collecting system or renal sinus; all others were categorized as peripheral. We used the Abbreviated Modification of Diet in Renal Disease study equation to estimate GFR preoperatively, in the early postoperative hospital stay, and at 1 and 12 months after surgery. Multivariate models were fit to determine the association of tumor location with changes in GFR at each time period after controlling for age, sex, tumor size, American Society of Anesthesia Score, ischemic time, operative time, and blood loss. Results: A total of 616 patients (265 central and 351 peripheral tumors) were available for analysis. Patients with central tumors were younger compared to those with peripheral tumors (62 vs. 59, p = 0.014), had longer intraoperative renal ischemia (40 vs. 30 min, respectively, p < 0.001), and had longer operations (201 vs. 184 min, respectively, p = 0.01). Although baseline GFR did not differ between the groups, a significantly larger decrease in GFR was found in patients with central compared to peripheral tumors in the early postoperative period (−16 vs. −11 cc/min/1.73 m2, p = 0.013) and 1-month follow-up (−10 vs. −6 cc/min/1.73 m2, p = 0.017). The GFR change was similar at 1-year follow-up, −10 and −11 cc/min/1.73m2 (p = 0.586) for central and peripheral tumors, respectively. On multivariate analysis, tumor location was not significantly associated with the change in GFR at any of the time intervals after adjusting for size, ischemic time, operative time, age, sex and comorbidity. Conclusions: Patients with centrally located tumors have a more pronounced short-term decrease in GFR, which reflects a longer operative time and ischemia duration. Tumor location does not appear to impact the long-term renal function. This suggests that renal sparing surgery should not be withheld from this subset of patients. No significant financial relationships to disclose.

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