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

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.

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

10.21203/rs.3.rs-97671/v1 ◽

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.

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

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.3.157 ◽

2019 ◽

Vol 91 (3) ◽

Cited By ~ 2

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.

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

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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Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

Ear Nose & Throat Journal ◽

10.1177/0145561319882786 ◽

2019 ◽

pp. 014556131988278

Author(s):

Carlos Miguel Chiesa-Estomba ◽

Jon Alexander Sistiaga-Suarez ◽

Jose Angel González-García ◽

Ekhiñe Larruscain ◽

Xabier Altuna-Mariezcurrena

Keyword(s):

Intraoperative Complications ◽

Tumor Resection ◽

Major Complication ◽

Preoperative Assessment ◽

Oncologic Outcomes ◽

Anatomical Location ◽

Complication Rates ◽

Inclusion Criteria ◽

Prospective Data ◽

Single Center Study

Introduction: Despite good outcomes of CO2 laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident. Materials and Methods: An observational, prospective, nonrandomized study. Results: One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors ( P = .001). We do not found difference in complications according to severity (minor vs major complication). Conclusion: Previous studies reported good oncologic outcomes and low complication rates with CO2 transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO2 TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

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

Proceedings of IMPRS ◽

10.18060/23462 ◽

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.

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Comparison of Robotic Versus Laparoscopic Partial Nephrectomy For Renal Tumors With A RENAL Nephrometry Score≥7: A System Review and Meta-Analysis

10.21203/rs.3.rs-443733/v1 ◽

2021 ◽

Author(s):

Jin-Biao Zhou ◽

Xin Xiao ◽

Tian-Li Shi ◽

Xiao-Hui Huang ◽

Yu-Li Jiang

Keyword(s):

Partial Nephrectomy ◽

Intraoperative Complications ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Positive Surgical Margin ◽

Robotic Partial Nephrectomy ◽

Cochrane Central Register ◽

Nephrometry Score ◽

Estimated Blood Loss

Abstract Background To compare the perioperative outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score≥7. Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score≥7. We used RevMan 5.2 to pool the data. Results Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p=0.54), hospital stay (WMD: -0.59; 95% CI: -1.24–0.06; p=0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p =0.23), major postoperative complications(OR: 0.90; 95% CI: 0.52–1.54; p=0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p =0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p=0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p=0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30–-6.62; p <0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p=0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p=0.04).Conclusions RPN showed better perioperative clinical outcomes than LPN for the treatment of complex renal tumors with a RENAL nephrometry score≥7.

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Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

The American Surgeon ◽

10.1177/0003134820948912 ◽

2020 ◽

pp. 000313482094891

Author(s):

Amber B. Tang ◽

Margherita Lamaina ◽

Christopher P. Childers ◽

Selene S. Mak ◽

Qiao Ruan ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Oncologic Outcomes ◽

Surgical Approaches ◽

Long Term Outcomes ◽

Robot Assisted ◽

Cancer Specific Survival ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss

Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.

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Use of a novel parenchymal clamp for laparoscopic and open partial nephrectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.936 ◽

2013 ◽

Vol 4 (5) ◽

pp. 133 ◽

Cited By ~ 2

Author(s):

Paul Toren ◽

Turki Al-Essawi ◽

Anthony Mclean ◽

Umesh Jain

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Oncologic Outcomes ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

Hilar Dissection ◽

Excellent Preservation ◽

Initial Results

Increasing data advocates the wider use of partial nephrectomy forrenal tumours amenable to this approach. We describe the initialNorth American use of a novel parenchymal clamp in an openand a laparoscopic partial nephrectomy. Initial results in 3 patients(2 open, 1 laparoscopic) demonstrate excellent preservation ofrenal function and good oncologic outcomes. Hilar dissection wasavoided in all cases and the estimated blood loss was low. In oursmall series, we found this device to be a safe and useful adjunctto partial nephrectomy.

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Robotic Partial Nephrectomy with the Da Vinci Xi

Advances in Urology ◽

10.1155/2016/9675095 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

George J. S. Kallingal ◽

Sanjaya Swain ◽

Fadi Darwiche ◽

Sanoj Punnen ◽

Murugesan Manoharan ◽

...

Keyword(s):

Partial Nephrectomy ◽

Da Vinci ◽

Intraoperative Complications ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Da Vinci Xi ◽

Port Placement ◽

Renal Masses ◽

Estimated Blood Loss ◽

Surgical Platform

Purpose.The surgical expertise to perform robotic partial nephrectomy is heavily dependent on technology. The Da Vinci Xi (XI) is the latest robotic surgical platform with significant advancements compared to its predecessor. We describe our operative technique and experience with the XI system for robotic partial nephrectomy (RPN).Materials and Methods.Patients with clinical T1 renal masses were offered RPN with the XI. We used laser targeting, autopositioning, and a novel “in-line” port placement to perform RPN.Results.15 patients underwent RPN with the XI. There were no intraoperative complications and no operative conversions. Mean console time was 101.3 minutes (range 44–176 minutes). Mean ischemia time was 17.5 minutes and estimated blood loss was 120 mLs. 12 of 15 patients had renal cell carcinoma. Two patients had oncocytoma and one had benign cystic disease. All patients had negative surgical margins and pathologic T1 disease. Two postoperative complications were encountered, including one patient who developed a pseudoaneurysm and one readmitted for presumed urinary tract infection.Conclusions.RPN with the XI system can be safely performed. Combining our surgical technique with the technological advancements on the XI offers patients acceptable pathologic and perioperative outcomes.

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