Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

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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Early Single-Center Experience with Robotic Partial Nephrectomy Using the da Vinci Xi: Comparative Assessment with Conventional Open Partial Nephrectomy

Current Urology ◽

10.1159/000499300 ◽

2019 ◽

Vol 13 (1) ◽

pp. 13-18 ◽

Cited By ~ 1

Author(s):

Daisuke Motoyama ◽

Ryota Aki ◽

Yuto Matsushita ◽

Keita Tamura ◽

Toshiki Ito ◽

...

Keyword(s):

Partial Nephrectomy ◽

Da Vinci ◽

Operative Procedure ◽

Surgical Margin ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Da Vinci Xi ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss

Background: The objective of this study was to evaluate our experience with robot-assisted partial nephrectomy (RAPN) in comparison with conventional open partial nephrectomy (OPN). Patients and Methods: This study included 37 and 50 patients undergoing OPN and RAPN for small renal masses, respectively. A single surgeon performed RAPN for all 50 cases using the da Vinci Xi. Trifecta was defined as satisfying all of the following 3 criteria: ischemic time of ≤ 25 minutes, negative surgical margin and no major postoperative complications. Results: After adjusting patient variables by 1:1 propensity-score matching, 37 patients were included in each group, and no significant differences in major clinicopathological characteristics were noted between these 2 groups. RAPN was significantly superior to OPN with respect to operative time, estimated blood loss and postoperative length of hospital stay. The rate of trifecta achievement was significantly higher in the RAPN group than in the OPN group (91.9 vs. 62.2%). Furthermore, the operative procedure and R.E.N.A.L. nephrometry score were found to be independently associated with trifecta outcome by multivariate analysis of the entire cohort. Conclusions: Although this is our early experience with 50 initial cases, RAPN using the da Vinci Xi resulted in more favorable perioperative outcomes than OPN.

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Improved perioperative outcomes by early unclamping prior to renorrhaphy compared with conventional clamping during robot-assisted partial nephrectomy: a propensity score matching analysis

Journal of Robotic Surgery ◽

10.1007/s11701-019-00924-3 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-53

Author(s):

Daisuke Motoyama ◽

Yuto Matsushita ◽

Hiromitsu Watanabe ◽

Keita Tamura ◽

Toshiki Ito ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Robot Assisted ◽

Propensity Score Matching Analysis

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PD20-04 PERIOPERATIVE OUTCOMES OF ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR MODERATELY AND HIGHLY COMPLEX T1B RENAL TUMORS

The Journal of Urology ◽

10.1016/j.juro.2017.02.890 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Önder Kara ◽

Matthew J. Maurice ◽

Pascal Mouracade ◽

Ercan Malkoç ◽

Julien Dagenais ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Open Partial Nephrectomy

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A Single Surgeon’s Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy

International Scholarly Research Notices ◽

10.1155/2014/430914 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Zachary Klaassen ◽

Robert M. Kohut ◽

Dhruti Patel ◽

Martha K. Terris ◽

Rabii Madi

Keyword(s):

Glomerular Filtration Rate ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Filtration Rate ◽

Patient Characteristics ◽

Laparoscopic Partial Nephrectomy ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Open Partial Nephrectomy ◽

Preoperative Patient

Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities—open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n=23), laparoscopic partial nephrectomy (LPN) (n=48), and robotic partial nephrectomy (RPN) (n=35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P=0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P<0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P=0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

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