scholarly journals Partial Nephrectomy A Comparison between Different Modalities

2021 ◽  
Vol 8 (2) ◽  
pp. 34-39
Author(s):  
Ahmed Al Asker ◽  
Abdulmalik Addar ◽  
Mohammed Alghamdi ◽  
Saud Alawad ◽  
Mohammed Alharbi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
Tumor Size ◽  
Robotic Partial Nephrectomy ◽  
Chi Square ◽  
Open Partial Nephrectomy ◽  
Institutional Review

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

Comparison of open and robotic nephron sparing surgery: a single centre experience

2016 ◽  
Vol 10 (1) ◽  
pp. 28-35
Author(s):  
Clare R Jelley ◽  
Kurukula ASH Kurukulaarachchi ◽  
Luke Forster ◽  
Harry Bardgett ◽  
Rajindra Singh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
High Volume ◽  
Robotic Partial Nephrectomy ◽  
Complication Rates ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Objective: To compare robotic partial nephrectomy (RAPN) with open partial nephrectomy (OPN) to assess efficacy and impact of learning curve. Methods: From 2010 to 2015 159 patients had a partial nephrectomy (82 OPN and 77 RAPN). All data were collected prospectively. We compared the demographics, peri and postoperative outcomes. Results: Mean age was 60 years in both groups; 59% of patients were men. Tumour size was larger in the open group (34 mm vs 30 mm; P<0.08), but RENAL nephrometry scores greater than 6 were comparable (over 60%). Mean ischaemic time was longer in the RAPN group (18 vs 13 minutes; P<0.04) but complication rates were similar. The RAPN cohort had a reduced estimated blood loss (100 ml vs 300 ml; P<0.01) and shorter median hospital stay (2 vs 5 days; P<0.01). Only two patients in each group were margin positive. The RAPN cohort demonstrated reduced estimated blood loss and a trend towards more complex tumours with increasing learning curve. Conclusion: RAPN is superior to OPN in terms of reduced hospital stay and estimated blood loss without compromising oncological outcomes. This service can be delivered safely and effectively in a low to medium volume cancer centre; these results are similar to published figures from high volume international centres.

Cost comparison of robotic, laparoscopic, and open partial nephrectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 394-394
Author(s):  
Mehrdad Alemozaffar ◽  
Steven Lee Chang ◽  
Ravi Kacker ◽  
Maryellen Sun ◽  
William C DeWolf ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Hospital Costs ◽  
Cost Comparison ◽  
Renal Tumors ◽  
Robotic Partial Nephrectomy ◽  
Fixed Costs ◽  
Average Hospital ◽  
Open Partial Nephrectomy

394 Background: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are increasingly common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. The cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. Methods: Variable hospital costs including operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory charges were captured for 25 patients who underwent OPN, LPN, and RPN at our institution between 11/2008 -9/2010. Fixed costs of acquisition of a laparoscopic suite and a robotic system (including maintenance) were amortized over 7 years. We considered alternative scenarios through one-way and multi-way sensitivity analysis. Results: We found similar overall variable costs for OPN, LPN, and RPN. Sensitivity analysis demonstrated that RPN and LPN are more cost effective than OPN (excluding fixed costs) if the average hospital stay is < 2 days, or OR time less is than 204 and 196 mins, respectively. By including fixed costs of equipment, RPN and LPN are always more costly than OPN. Conclusions: There was no difference among variable hospital costs of OPN, LPN, and RPN. Minimizing OR time and hospital stay reduces RPN and LPN costs to levels comparable to OPN. Inclusion of fixed costs makes LPN and RPN more expensive than OPN, but increased utilization and efficiency can decrease cost per case. [Table: see text]

scholarly journals Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Syed Ali Ehsanullah ◽  
Abida Sultana ◽  
Brian Kelly ◽  
Charlotte Dunford ◽  
Zaheer Shah
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Tumour Size ◽  
Open Approach ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

Long-term renal outcomes in obese patients after minimally invasive vs. open partial nephrectomy for the treatment of renal cancer – A retrospective study (Preprint)

2020 ◽  
Author(s):  
Brittany Roses ◽  
Bradley Jarrett Stone ◽  
SHELBIE Stahr ◽  
Mahmoud Khalil ◽  
Rodney Davis ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Invasive Surgery ◽  
Robotic Partial Nephrectomy ◽  
Obese Patients ◽  
Open Partial Nephrectomy ◽  
Renal Outcomes ◽  
Post Surgery

BACKGROUND Obesity has a significant association with renal cell carcinoma (RCC). Surgery is the preferred treatment of demarcated RCC. Obesity increases the complexity of surgical outcomes. There is a paucity of data regarding surgical technique outcomes in obese patients. OBJECTIVE We investigated short- and long-term renal outcomes in obese patients post-RCC surgery through open, laparoscopic, or robotic partial nephrectomy. METHODS This is a retrospective chart review of obese patients after open, laparoscopic, or robotic partial-nephrectomies over 12 years at a single center. The obese (BMI ≥ 30) and the non-obese (BMI< 30) patients were studied in 2-time frames: short (3-6 months post-surgery), or long (> 6 months) and followed up to 4 years. RESULTS Of the 140 patients, 75 were obese and 65 were non-obese. In the obese, 3-6 months after minimally-invasive surgery, the odds of having a decrease or no change in creatinine values were 0.62 times lower compared to open surgery. Over 6 months after minimally-invasive surgery, the odds were 1.24 times higher. Neither of these results were statistically significant. In the non-obese group, at 3-6 months after minimally-invasive surgery, the same odds were 4.86 times higher. This was statistically significant (P<0.05). Over 6 months after minimally invasive surgery, the odds were 4.13 times higher. This was not statistically significant. CONCLUSIONS We observed non-statistically significant preservation of renal function in obese patients undergoing OPN at 3-6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating a long-term benefit of MIPN. In the non-obese, MIPN was favored over OPN. CLINICALTRIAL na

scholarly journals Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome

2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
Author(s):  
Bilal Chughtai ◽  
Christa Abraham ◽  
Daniel Finn ◽  
Stuart Rosenberg ◽  
Bharat Yarlagadda ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Clinical Pathway ◽  
Tumor Size ◽  
Fast Track ◽  
Foley Catheter ◽  
Control Group ◽  
Open Partial Nephrectomy ◽  
Postoperative Length

Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway.Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD). Defined goals are (1) ambulation and liquid diet on the evening of the operative day; (2) out of bed (OOB) at least 4 times on POD 1; (3) removal of Foley catheter on the morning of POD 2; (4) removal of Jackson Pratt drain on the afternoon of POD 2; (4) discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway.Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61%) out of 36 fast track patients and 4 (16%) out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days;P= .012). Age (median, 55 versus 57 years), tumor size (median, 2.5 versus 2.5 cm), readmission within 30 days (5.5% versus 5.1%), and complications (10.2% versus 13.8%) were similar in the fast track patients and control, respectively.Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

Hand-assisted laparoscopic nephrectomy in morbidly obese patients

2020 ◽  
Vol 99 (6) ◽  
pp. 271-276
Keyword(s):  
Body Weight ◽  
Surgical Technique ◽  
Blood Loss ◽  
Hospital Stay ◽  
Kidney Cancer ◽  
The Body ◽  
Laparoscopic Nephrectomy ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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).

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