scholarly journals Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

2020 ◽  
Author(s):  
Xiaotao Yin ◽  
Sinan Jiang ◽  
Zhiqiang Shao ◽  
Yongliang Lu ◽  
Jiangxiang Guo ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Operation Time ◽  
Rotation Group ◽  
Control Group ◽  
Positive Surgical Margin ◽  
Retrospective Case ◽  
Estimated Blood Loss ◽  
Rotation Technique ◽  
Hilar Tumor

Abstract Purpose: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. We developed a novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN, and evaluated its efficacy in a retrospective case-control comparative .Methods: From March 2016 to April 2019, a total of 39 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique, which improved the tumor exposure by opening the peritoneum and rotating the kidney ventrally, was applied in 24 cases and the conventional RAPN was performed in the other 15 cases (control group). Perioperative data was analyzed to evaluate the efficacy of the kidney ventrally rotation technique.Results: In kidney rotation group, the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The warm ischemia time was 17.4 ± 6.6 min, which was significantly shorter than 24.5 ± 8.3 min in control group. The mean operation time (80 ± 24 min) and estimated blood loss (104 ± 65 ml) were not different from control group. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.Conclusion: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient option for the management of posterior hilar tumor.

scholarly journals Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

2020 ◽  
Author(s):  
Xiaotao Yin ◽  
Sinan Jiang ◽  
Zhiqiang Shao ◽  
Yongliang Lu ◽  
Jiangxiang Guo ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Case Series ◽  
Surgical Margin ◽  
Operation Time ◽  
Positive Surgical Margin ◽  
Estimated Blood Loss ◽  
Rotation Technique ◽  
The Mean ◽  
Special Location ◽  
Hilar Tumor

Abstract Purpose: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. A novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN was developed, and its efficacy was assessed in a consecutive case series.Methods: From April 2017 to April 2019, a total of 24 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique was applied in all these cases, which specialized in improving the exposure of posterior hilar tumor by rotating the kidney ventrally. Perioperative data was analyzed to evaluate the efficacy of this technique.Results: The mean tumor size was 4.3 ± 1.7 cm (range 2.5-8 cm), and the median R.E.N.A.L score was 9 (range 7-12). All the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The mean operation time was 80 ± 24 min, the mean estimated blood loss was 104 ± 65 ml, and the warm ischemia time was 17.4 ± 6.6 min. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.Conclusion: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient method for the management of posterior hilar tumor.KEYWORDS: robotic surgery; partial nephrectomy; posterior hilar tumor; retroperitoneal approach; kidney rotation

scholarly journals Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours

2017 ◽  
Vol 89 (2) ◽  
pp. 93 ◽  
Author(s):  
Abdulmuttalip Simsek ◽  
Abdullah Hizir Yavuzsan ◽  
Yunus Colakoglu ◽  
Arda Atar ◽  
Selcuk Sahin ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Laparoscopic Partial Nephrectomy ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Asa Score ◽  
Estimated Blood Loss ◽  
Renal Tumours ◽  
Significant Difference

Objective: To evaluate a single surgeon oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared to robotic partial nephrectomy (RPN) for pT1a renal tumours. Materials and methods: Between 2006 and 2016, a retrospective review of 42 patients who underwent LPN (n = 20) or RPN (n = 22) by same surgeon was performed. Patients were matched for gender, age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, tumour side, RENAL and PADUA scores, peri-operative and post-operative outcomes. Results: There was no significant differences between the two groups with respect to patient gender, age, BMI, ASA score, tumours side, RENAL and PADUA scores. Mean operative time for RPN was 176 vs. 227 minutes for LPN (p = 0.001). Warm ischemia time was similar in both groups (p = 0.58). Estimated blood loss (EBL) was higher in the LPN. There was no significant difference with preoperative and postoperative creatinine and percent change in eGFR levels. Only one case in LPN had positive surgical margin. Conclusions: RPN is a developing procedure, and technically feasible and safe for small-size renal tumours. Moreover RPN is a comparable and alternative operation to LPN, providing equivalent oncological and functional outcomes, as well as saving more healthy marginal tissue and easier and faster suturing.

scholarly journals Comparison of early experience laparoscopic versus open partial nephrectomy in terms of clinical, oncological and renal functional outcomes

2021 ◽  
pp. 116-123
Author(s):  
Mert Kılıç ◽  
Meftun Çulpan ◽  
Asıf Yıldırım ◽  
Turhan Çaşkurlu
Keyword(s):  
Local Recurrence ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Renal Tumors ◽  
Positive Surgical Margin ◽  
Open Partial Nephrectomy ◽  
Renal Functions ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objective: Although laparoscopic partial nephrectomy (LPN) is minimally invasive, it is also a technically challenging procedure. Currently, open partial nephrectomy (OPN) remains the only alternative in many centers for T1 kidney tumors. We reported our initial experience of LPN compared to OPN regarding clinical, oncological findings and renal functions. Material and Methods: Between 2004-2013, 81 patients who underwent OPN (n=55) or LPN (n=26) for clinically T1 renal tumors were included. Perioperative and postoperative data were compared, retrospectively. Follow-up times for OPN and LPN groups were 72.9± 41.1 and 47.6± 32.4 months, respectively (p<0.05). Results: The mean tumor size and RENAL nephrometry scores were similar for both groups.  Zero-ischemia was performed in all of the LPN and 15% of the OPN procedures. Estimated blood loss and perioperative transfusion rates were higher in OPN group. Complications including grade < 3 and  ≥ 3 did not differ significantly between the groups. The decrease in creatinine-clearance at 6th month was statistically significant in OPN group, while stable in LPN. Positive surgical margin rates were 6.6% for OPN and 17.6% for LPN, p=0.19. One patient in LPN developed local recurrence and underwent nephrectomy. In OPN group,one local recurrence and one distant metastasis were observed in two independent patients. Both patients recieved tyrosine kinase inhibitor. Conclusion: Although LPN is accepted as a technically challenging procedure, LPN provided comparable outcomes to OPN including clinical, oncological findings and renal functions, even in the early learning phase. Zero-ischemia technique for LPN was feasible and safe with favorable perioperative and renal functional outcomes. Keywords: laparoscopy; learning curve; partial nephrectomy; renal cancer; surgical margins; zero-ischemia.

scholarly journals Clinical Efficacy and Safety of Silicone Elastomer Sheet during Decompressive Craniectomy: Anti-Adhesive Role in Cranioplasty

2021 ◽  
Vol 11 (1) ◽  
pp. 124
Author(s):  
Young Ha Kim ◽  
Chi Hyung Lee ◽  
Chang Hyeun Kim ◽  
Dong Wuk Son ◽  
Sang Weon Lee ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Fluid Collection ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Silicone Elastomer ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Adhesion Tissue ◽  
Skull Bone Defect ◽  
Epidural Adhesion

(1) Background: Cranioplasty is a surgery to repair a skull bone defect after decompressive craniectomy (DC). If the process of dissection of the epidural adhesion tissue is not performed properly, it can cause many complications. We reviewed the effect of a silicone elastomer sheet designed to prevent adhesion. (2) Methods: We retrospectively reviewed 81 consecutive patients who underwent DC and subsequent cranioplasty at our institution between January 2015 and December 2019. We then divided the patients into two groups, one not using the silicone elastomer sheet (n = 50) and the other using the silicone elastomer sheet (n = 31), and compared the surgical outcomes. (3) Results: We found that the use of the sheet shortened the operation time by 24% and reduced the estimated blood loss (EBL) by 43% compared to the control group. Moreover, the complication rate of epidural fluid collection (EFC) in the group using the sheet was 16.7%, which was lower than that in the control group (41.7%, p < 0.023). Multivariate logistic regression analysis showed the sheet (OR 0.294, 95% CI 0.093–0.934, p = 0.039) to be significantly related to EFC. (4) Conclusions: The technique using the silicone elastomer sheet allows surgeons to easily dissect the surgical plane during cranioplasty, which shortens the operation time, reduces EBL, and minimizes complications of EFC.

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

2021 ◽  
pp. 039156032110016
Author(s):  
Francesco Chiancone ◽  
Marco Fabiano ◽  
Clemente Meccariello ◽  
Maurizio Fedelini ◽  
Francesco Persico ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operation Time ◽  
Renal Tumors ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience

2018 ◽  
Vol 36 (7) ◽  
pp. 1093-1101 ◽  
Author(s):  
Firas G. Petros ◽  
Michael J. Metcalfe ◽  
Kai-Jie Yu ◽  
Sarp K. Keskin ◽  
Bryan M. Fellman ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Single Institution

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

2019 ◽  
Vol 13 (1) ◽  
pp. 13-18 ◽  
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.

Does the day or season of operation predict biochemical recurrence after radical prostatectomy?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16162-e16162
Author(s):  
A. L. Hirsh ◽  
D. J. Lee ◽  
G. Hruby ◽  
M. C. Benson ◽  
J. M. McKiernan
Keyword(s):  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Cox Regression ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Urologic Oncology ◽  
Mortality And Morbidity ◽  
Estimated Blood Loss ◽  
Day Of The Week ◽  
The Mean

e16162 Background: Outcomes in hospital based medicine are associated with the experience and availability of the medical staff, as mortality and morbidity rates increase each summer with new medical graduates. Hospital staff members are thought to be more fatigued and less available towards the end of the week and on weekends. However it is not known if there is a difference of outcomes based on the season or day of the week. We sought to identify if different seasons or surgical days of the week can predict poor outcomes and biochemical recurrence (BCR) in radical prostatectomy (RP). Methods: A retrospective analysis of the Columbia Urologic Oncology database was performed. 1865 consecutive men underwent RP from 1991 to 2008 by three surgeons. Data was collected in an institutional review board approved registry, with median follow up of 36 months. BCR was defined as two consecutive PSA levels > 0.2 ng/ml. Stratified cox regression methods were used to model the relationship between surgeon, preoperative variables, season, day of the week, and BCR. Winter was defined as December through February, spring as March through May, summer as June through August, and fall as September through November. Results: The mean age of the men undergoing RP was 61.2 years (37–79), with a mean preoperative PSA of 8.12. 424 men (22.7%) had positive surgical margins, and the mean estimated blood loss (EBL) was 1119cc. Patient age (p=0.68), preoperative PSA (p=0.32), EBL (p=0.51), and positive surgical margin rate (p=0.78) were not significantly different between each day. Men undergoing RP did not have different rates of BCR according to the day of the operation (p=0.58) or season (p=0.997). The particular season and day of the operation were not significantly associated with BCR, and were not independent predictors of BCR in a multivariable model after adjusting for preoperative PSA, Gleason sum, tumor stage, and surgeon. Conclusions: Patient surgical outcomes and BCR rates after RP are not associated with the particular season or day of the week of the procedure. These findings suggest that men undergoing RP do not need to be concerned about the particular season or day when scheduling the procedure. No significant financial relationships to disclose.

scholarly journals Does Changeover by an Experienced Open Prostatic Surgeon from Open Retropubic to Robot-Assisted Laparoscopic Prostatectomy Mean a Step Forward or Backward?

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Musch ◽  
Ulla Roggenbuck ◽  
Virgilijus Klevecka ◽  
Heinrich Loewen ◽  
Maxim Janowski ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Operating Time ◽  
Surgical Margin ◽  
Patient Characteristics ◽  
Positive Surgical Margin ◽  
Laparoscopic Prostatectomy ◽  
Surgery Patient ◽  
Equivalent Number ◽  
Estimated Blood Loss ◽  
Patient Reported

We assessed whether changeover from open retropubic [RRP] to robotic-assisted laparoscopic prostatectomy [RALP] means a step forward or backward for the initial RALP patients. Therefore the first 105 RALPs of an experienced open prostatic surgeon and robotic novice—with tutoring in the initial 25 cases—were compared to the most recent 105 RRPs of the same surgeon. The groups were comparable with respect to patient characteristics and postoperative tumor characteristics (all P>0.09). The only disadvantage of RALP was a longer operating time; the advantages were lower estimated blood loss, fewer anastomotic leakages, earlier catheter removal, shorter hospital stay (all P<0.04), and less major complications within 90 days postoperatively (P<0.01). Positive surgical margin rates were comparable both overall and stratified for pT stage in both groups (all P<0.08). In addition, an equivalent number of lymph nodes were removed (P>0.07). Twelve months after surgery, patient reported continence and erectile function were comparably good (all P>0.11). Our study indicates that an experienced open prostatic surgeon and robotic novice who switches to RALP can achieve favorable surgical results despite the initial RALP learning curve. At the same time neither oncological nor functional outcomes are compromised.

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