scholarly journals INVESTIGATING A NOVEL MODIFIABLE FACTOR AFFECTING RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY: CORTICAL RENORRHAPHY

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Anna Fenner ◽  
Clint Bahler, MD
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Controlled Trial ◽  
Tumor Resection ◽  
Volume Loss ◽  
Selective Embolization ◽  
Renal Masses ◽  
Urine Leak ◽  
Modifiable Factor

Background: Partial nephrectomy is a common treatment for the removal of renal masses. Typically, during the procedure, stitches are used to close two layers of the kidney—both deep and superficial. Renorrhaphy of the superficial layer, thought to reduce the risk of bleeding and urine leak, is routinely performed but has not been sufficiently studied. Hypothesis: Cortical renorrhaphy is a modifiable factor affecting renal function after partial nephrectomy. Omitting this step will preserve renal parenchyma without significantly increasing complications. Methods: A randomized, controlled trial is underway. Interim statistical analysis has been performed on the data being collected. Patients underwent partial nephrectomy with or without cortical renorrhaphy according to their randomized group assignment. Three-dimensional models were constructed using semi-automatic segmentation planimetry of the kidney prior to surgery and at 4-months after tumor resection to determine volume loss in the operated kidney. Results: The median (range) volume loss in the non-renorrhaphy group (n=8), 13% (0-24%), was trending lower than the renorrhaphy group (n=8), 22% (12-39). Using multiple linear regression, experimental group (p=0.0808) and warm-ischemia time (p=0.0995) were significant at the 0.1 level. Tumor size was not statistically significant (p=0.2644). There was one Clavien 3 complication in each group: The renorrhaphy group had one urine leak requiring a drain, and the non-renorrhaphy group had one postoperative bleed requiring selective embolization. Demographics were comparable among the two groups with both having 4 white males and 4 white females. The mean age (58 and 55 for renorrhaphy and non-renorrhaphy, respectively) and tumor size were also comparable. Conclusion and impact: A trend of increased volume loss from cortical renorrhaphy is seen as predicted by retrospective data. Completion of the trial is needed to conclude whether this is statistically significant.

Influence of 3D-Calculated Parenchymal Volume Loss on Renal Function After Partial Nephrectomy

2021 ◽  
Author(s):  
Mustafa Erkoc ◽  
Huseyin Besiroğlu ◽  
Sait Özbir ◽  
Lutfi Canat ◽  
Burak Değirmentepe ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Volume Loss

scholarly journals PD11-12 INVESTIGATING A NOVEL MODIFIABLE FACTOR AFFECTING RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY

2020 ◽  
Vol 203 ◽  
pp. e258
Author(s):  
Anna Fenner* ◽  
Chandru Sundaram ◽  
Clinton Bahler
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Modifiable Factor

scholarly journals Absorbable Self-Retaining Barbed Double-Needle Suture(SRBDS) in Transperitoneal Laparoscopic Partial Nephrectomy for T1 Renal Neoplasms

2021 ◽  
Author(s):  
HaiBin Wei ◽  
YuChen Bai ◽  
Qi Zhang ◽  
ZuJie Mao ◽  
EnHui Li ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Oncologic Outcomes ◽  
Renal Neoplasm ◽  
Renal Neoplasms ◽  
Selective Embolization ◽  
Bleeding Vessel ◽  
Estimated Blood Loss ◽  
Post Operation

Abstract ObjectiveTo evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed.ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period.ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

scholarly journals Safety and efficacy of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy for low nephrometry score masses

2019 ◽  
Vol 91 (3) ◽  
Author(s):  
Emanuele Corongiu ◽  
Pietro Grande ◽  
Angelo Di Santo ◽  
Giorgio Pagliarella ◽  
Stefano Squillacciotti ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Functional Results ◽  
Laparoscopic Partial Nephrectomy ◽  
Tumor Diameter ◽  
Selective Embolization ◽  
Renal Masses ◽  
Nephrometry Score ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objectives: To evaluate oncological feasibility and oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN). Patients and methods: Patients with posterior renal masses with low nephrometry score (RENAL ≤ 7) treated who underwent retroperitoneal sutureless zero ischemia.in a single center from January 2016 to November 2017. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the modified Clavien classification. Results: Retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy was performed on 15 patients. The indication for nephron-sparing surgery was elective in 11 (73%) patients and imperative in 4 (27%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). There were no intraoperative complications. No cases were converted to radical nephrectomy, and in no case parenchyma suture was necessary. Median operative time was 90 min (IQR:40-150), in no case clamping of the renal artery was necessary, median hospital stay was 4 days, median estimated blood loss (EBL) was 310 (180-500) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%), 9 (60%) staged T1a and 2 (13%) T1b. In 4 (27%) an oncocytoma was found. There were no positive surgical margins. One patient developed a major postoperative complication (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 93%. Conclusions: Sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses showed to be safe and feasible. Longer follow-up and higher numbers of patients are, however, warranted to draw definitive conclusions on functional outcomes.

scholarly journals Laparoscopic Nephrectomy,Ex VivoPartial Nephrectomy, and Autotransplantation for the Treatment of Complex Renal Masses

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Jasmir Gopal Nayak ◽  
Joshua Koulack ◽  
Thomas Brian McGregor
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Ex Vivo ◽  
Laparoscopic Nephrectomy ◽  
Cell Renal Cell Carcinoma ◽  
Renal Masses ◽  
Local Experience ◽  
Nephron Sparing ◽  
Stable Renal Function ◽  
Clinical Dilemma

In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy,ex vivopartial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

scholarly journals Absorbable self-retaining barbed double-needle suture(SRBDS) in transperitoneal laparoscopic partial nephrectomy for T1 renal neoplasms

2020 ◽  
Author(s):  
Hai-bin Wei ◽  
Yu-chen Bai ◽  
Qi Zhang ◽  
Zu-jie Mao ◽  
En-hui Li ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Oncologic Outcomes ◽  
Renal Neoplasm ◽  
Renal Neoplasms ◽  
Selective Embolization ◽  
Bleeding Vessel ◽  
Estimated Blood Loss ◽  
Post Operation

Abstract PurposeThe purpose of study was to evaluate the safety and hemostatic efficacy of absorbable self-retaining barbed double-needle suture (SRBDS) in transperitoneal LPN for T1 renal neoplasms.MethodsIn total, 75 patients with renal neoplasm masses (< 7 cm) undergoing transperitoneal LPN were collected since January 2018 to October 2019. After tumor resection with a cold Endoscissor, 3-0 and 0 SRBDS was performed for inner and outer running stitches without either hem-o-lok or LapraTy clip, respectively. Patient demographic information, neoplasm characteristics, perioperative factors, and oncologic outcomes were collected and analyzed. ResultsAccording to our result, Median tumor size and R.E.N.A.L score was 4.69 cm and 7. Median operative time and overall warm ischemia time was 73 min and 13.14 min. Mean estimated blood loss was 67 ml. intraoperative complications was not showing up and no case was switched to open radical nephrectomy. Postoperative pathological assessment confirmed that negative surgical margins. only single patient experienced secondary surgery-related hemorrhage on the fifth day post-operation, and was treated by transfusion and digital subtraction angiography (DSA) highly selective embolization of the bleeding vessel. No patients developed urinoma or urinary fistula. the overall complications were manageable during three-year follow-up period. ConclusionSRBDS was a safe and efficient surgical endoscopic suturing technique with low complication rate in T1 renal neoplasms, which might be considered as an alternative to other suturing techniques, tissue sealants and glues for partial nephrectomy in the future.

scholarly journals Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of Oncological Outcome and Impact on the Renal Function

2021 ◽  
Vol 84 (1) ◽  
pp. 2262-2269
Author(s):  
Mahmoud Amer ◽  
Mohamed Selim ◽  
Mohamed Elshazly ◽  
Sultan Sultan
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Critical Analysis ◽  
Radical Nephrectomy ◽  
Oncological Outcome ◽  
Renal Masses

scholarly journals Canadian Update on Surgical Procedures (CUSP) Urology Group consensus for intraoperative hemostasis during minimally invasive partial nephrectomy

2020 ◽  
Vol 14 (9) ◽  
Author(s):  
Douglas C. Cheung ◽  
Christopher J.D. Wallis ◽  
Simon Possee ◽  
Camilla Tajzler ◽  
Maurice Anidjar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Surgical Procedures ◽  
Delphi Method ◽  
Tumor Resection ◽  
Renal Masses ◽  
Steep Learning Curve ◽  
Modified Delphi ◽  
Laparoscopic Equipment ◽  
Survey Questionnaires

Introduction: Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes. Methods: A three-step modified Delphi method was used to achieve expert agreement on the best practices for hemostasis in MIPN. Panelists were recruited from the Canadian Update on Surgical Procedures (CUSP) Urology Group, which represent all provinces, academic and community practices, and fellowship- and non-fellowship-trained surgeons. Thirty-two (round 1) and 46 (round 2) panellists participated in survey questionnaires, and 22 attended the in-person consensus meeting. Results: An initial literature search of 945 articles (230 abstracts) underwent screening and yielded 24 preliminary techniques. Through sequential survey assessment and in-person discussion, a total of 11 strategies were approved. These are temporally distributed prior to tumor resection (five principles), during tumor resection (two principles), and during renorrhaphy (four principles). Conclusions: Given the variability in tumor size, depth, location, and vascularity, coupled with limitations of laparoscopic equipment, achieving consistent hemostasis in MIPN may be challenging. Despite over two decades of MIPN experience, limited evidence exists to guide clinicians. Through a three-step Delphi method and rigorous iterative review with a panel of experts, we ascertained a guiding checklist of principles for newly beginning and practicing urologists to reference.

Excisional Precision Matters: Understanding the Influence of Excisional Volume Loss on Renal Function After Partial Nephrectomy

2017 ◽  
Vol 72 (2) ◽  
pp. 168-170 ◽  
Author(s):  
Julien Dagenais ◽  
Matthew J. Maurice ◽  
Pascal Mouracade ◽  
Onder Kara ◽  
Ercan Malkoc ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Volume Loss
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