Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

Abstract Purpose: To compare the trifecta outcome and perioperative and postoperative outcomes among open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted partial nephrectomy (RAPN) in patients with small renal masses in Ramathibodi Hospital.Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy from January 2009 to December 2018. The baseline characteristics and preoperative outcomes were compared among the three surgical approaches. Results: Among the 141 patients, 42 (29.79%), 29 (20.57%), and 70 (49.64%) patients underwent OPN, LPN, and RAPN, respectively. Among 116 patients with available data, 71 achieved the trifecta outcome [18 (56.25%), 14 (56.00%), and 39 (73.58%) in the OPN, LPN, and RAPN group, respectively; p=0.276]. The rate of conversion to OPN was higher in the LPN than RAPN group. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. The estimated blood loss was significantly lower in the LPN group than OPN and RAPN groups (p=0.041). The operative time was shorter in the OPN group than LPN and RAPN groups (p<0.001). Multivariate analysis showed that the intraoperative complication rate was a predictive factor for trifecta outcome achievement.Conclusion: OPN had the shortest operative time. LPN had the highest rate of conversion to OPN and lowest estimated blood loss. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. However, achievement of the trifecta outcome was not significantly different among the three groups. The predictive factor for trifecta outcome achievement was the intraoperative complication rate.

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Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

Surgical Techniques Development ◽

10.4081/std.2013.e3 ◽

2013 ◽

Vol 3 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Nosratollah Nezakatzgoo ◽

Janet Colli ◽

Matthew Mutter ◽

Sheg Aranmolate ◽

Robert Wake

Keyword(s):

Partial Nephrectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Oral Intake ◽

Pathological Examination ◽

Tumor Diameter ◽

Renal Masses ◽

Estimated Blood Loss ◽

Average Operative Time

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

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Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

Canadian Urological Association Journal ◽

10.5489/cuaj.3197 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 859 ◽

Cited By ~ 12

Author(s):

Newaj Abdullah ◽

Deepansh Dalela ◽

Ravi Barod ◽

Jeff Larson ◽

Michael Johnson ◽

...

Keyword(s):

Regression Analysis ◽

Blood Loss ◽

Partial Nephrectomy ◽

Operative Time ◽

Independent Predictor ◽

Operating Time ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Obese Patients ◽

Estimated Blood Loss

Introduction: We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database. Methods: We identified 1836 patients who underwent RPN from five academic centres from 2006-2014. A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m2). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.Results: A total of 806 (44%) patients were obese with median BMI of 33.8kg/m2. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p<0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p<0.001), operative time (180 vs. 166 min, p<0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.Conclusion: In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss. However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT. Our results indicate that obesity alone should not preclude consideration for RPN.

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The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856167 ◽

2019 ◽

Vol 26 (6) ◽

pp. 744-752

Author(s):

Hailun Zhan ◽

Chunping Huang ◽

Tengcheng Li ◽

Fei Yang ◽

Jiarong Cai ◽

...

Keyword(s):

Renal Function ◽

Blood Loss ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Self ◽

Barbed Suture ◽

Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

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ROBOTIC ASSISTED PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL MASSES: FEASIBILITY AND RESULTS OF INITIAL EXPERIENCE

The Journal of Urology ◽

10.1016/s0022-5347(09)61512-3 ◽

2009 ◽

Vol 181 (4) ◽

pp. 536

Author(s):

Ronald S Boris ◽

Miguel Proano ◽

Craig G Rogers ◽

W. Marston Linehan ◽

Peter A Pinto ◽

...

Keyword(s):

Partial Nephrectomy ◽

Initial Experience ◽

Renal Masses ◽

Robotic Assisted ◽

Multiple Renal Masses ◽

Robotic Assisted Partial Nephrectomy

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Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study

Journal of Clinical Medicine ◽

10.3390/jcm10102181 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2181

Author(s):

Marco V. Marino ◽

Adrian Kah Heng Heng Chiow ◽

Antonello Mirabella ◽

Gianpaolo Vaccarella ◽

Andrzej L. Komorowski

Keyword(s):

High Risk ◽

Blood Loss ◽

Pancreatic Fistula ◽

Operative Time ◽

Risk Group ◽

High Risk Group ◽

Retrospective Case ◽

Pancreatic Anastomosis ◽

Robotic Assisted ◽

Estimated Blood Loss

Background: Different techniques of pancreatic anastomosis have been described, with inconclusive results in terms of pancreatic fistula reduction. Studies comparing robotic pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are scarcely reported. Methods: The present study analyzes the outcomes of two case-matched groups of patients who underwent PG (n = 20) or PJ (n = 40) after pancreaticoduodenectomy. The primary aim was to compare the rate of post-operative pancreatic fistula. Results: Operative time (375 vs. 315 min, p = 0.34), estimated blood loss (270 vs. 295 mL, p = 0.44), and rate of clinically relevant post-operative pancreatic fistula (12.5% vs. 10%, p = 0.82) were similar between the two groups. PJ was associated with a higher rate of intra-abdominal collections (7.5% vs. 0%, p = 0.002), but lower post-pancreatectomy hemorrhage (2.5% vs. 10%, p = 0.003). PG was associated with a lower rate of post-operative pancreatic fistula (POPF) (33.3% vs. 50%, p = 0.003) in the high-risk group of patients. Conclusions: The outcomes of post-operative pancreatic fistula are comparable between the two reconstruction techniques. PG may have a lower incidence of POPF in patients with high-risk of pancreatic fistula.

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

Urologia Journal ◽

10.1177/0391560320921728 ◽

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.

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

Advances in Urology ◽

10.1155/2021/5569254 ◽

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.

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