Comparison of robotic and laparoscopic partial nephrectomy for small renal tumours

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.

Download Full-text

Comparison Robotic versus laparoscopic partial nephrectomy for Complex Renal Tumors (with a RENAL nephrometry score≥7): a meta-analysis

10.21203/rs.3.rs-90761/v1 ◽

2020 ◽

Author(s):

Yu-Li Jiang ◽

Xin Xiao ◽

Fu-Sheng Peng ◽

Tian-Li Shi ◽

Xiao-Hui Huang ◽

...

Keyword(s):

Partial Nephrectomy ◽

Operating Time ◽

Surgical Margin ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Cochrane Central Register ◽

Intraoperative Complication ◽

Estimated Blood Loss

Abstract BackgroundTo compare the perioperative outcomes of Robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN). MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes RPN and LPN in patients with a RENALnephrometry score≥7. We used RevMan 5.2 to pool the data. ResultsSeven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 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), operating time (WMD: -22.45, 95%CI: -35.06 to-9.85, ), postive surgical margin (OR: 0.85, 95% CI 0.65–1.11, p =0.23) and transfusion (OR: 0.72, 95% CI 0.48–1.08, p =0.11).between the two groups. RPN get better outcomes in postoperative renal function (WMD: 3.32, 95% CI 0.73–5.91, p=0.01), warm ischenia time (WMD: -6.96, 95% CI -7.30–-6.62, p <0.0001), conversion( OR: 0.34, 95%CI: 0.17 to 0.66, p=0.002) and intraoperative complication (OR: 0.52, 95% CI 0.28–0.97, p=0.04).ConclusionRPN could get better perioerative clinical outcomes than LPN for treatment of Complex Renal Tumors( with a RENALnephrometry score≥7).

Download Full-text

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.

Download Full-text

Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy: Oncologic and Functional Outcomes in 49 Patients

Advances in Urology ◽

10.1155/2016/8045210 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Kalen Rimar ◽

Aziz Khambati ◽

Barry B. McGuire ◽

David A. Rebuck ◽

Kent T. Perry ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Comparison Group ◽

Positive Surgical Margin ◽

Robotic Partial Nephrectomy ◽

Transfusion Rate ◽

Urine Leak ◽

Significant Difference

Introduction and Objectives. Robotic partial nephrectomy with peritumoral radiofrequency ablation (RFA-RPN) is a novel clampless technique. We describe oncologic and functional outcomes in a prospective cohort. Methods. From May, 2007, to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RFA-RPN. During this period, only the RFA-RPN technique was utilized for all cases of partial nephrectomy. Pre- and postoperative data were analyzed and compared to 36 consecutive patients who underwent LPN. Results. In total, 49 tumors were treated in the RFA-RPN group and 36 tumors in the comparison group. Mean operative time was longer in the RFA-RPN group (370 min versus 293 min, p<0.001). There were no significant differences in mean EBL (231 cc versus 250 cc, p=0.42), transfusion rate (8.2% versus 11.1%, p=0.7), or hospital stay (3.9 versus 4.4 days, p=0.2). Two patients in the RFA-RPN (4.1%) and 1 (2.7%) patient in the comparison group had a positive surgical margin (p=0.75). 17 (34.7%) patients had a postoperative urine leak in the RFA-RPN group versus 2 (5.6%) patients in the comparison group (p=0.001). Mean follow-up was 54 months versus 68.4 months in the comparison group. There was no significant difference between the two groups regarding change in GFR (p=0.67). There were 3 recurrences (6.1%) in the RFA-RPN group and 0 recurrences in the RPN group (p=0.23). There were 3 deaths (6.1%) in the RFA-RPN group (one cancer specific) and 4 deaths (11.1%) in the RPN group (non-cancer specific) over the follow-up period (p=0.44). Conclusions. Our data suggests that this technique is associated with a similar degree of renal preservation but higher rates of postoperative urine leak and possibly higher rates of recurrence.

Download Full-text

Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

Frontiers in Oncology ◽

10.3389/fonc.2020.592193 ◽

2021 ◽

Vol 10 ◽

Author(s):

Daqing Zhu ◽

Xue Shao ◽

Gang Guo ◽

Nandong Zhang ◽

Taoping Shi ◽

...

Keyword(s):

Partial Nephrectomy ◽

Publication Bias ◽

Comparative Studies ◽

Operative Time ◽

Cochrane Library ◽

Positive Surgical Margin ◽

Robotic Partial Nephrectomy ◽

Estimated Blood Loss ◽

Significant Difference ◽

Matched Design

BackgroundTo compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).MethodsA literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% conﬁdence intervals (CIs) were estimated using ﬁxed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.ResultsEleven studies embracing 2,984 patients were included. There was no signiﬁcant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P < 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P < 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.ConclusionRRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.

Download Full-text

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

Yeni Üroloji Dergisi ◽

10.33719/yud.2021;16-2-792827 ◽

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.

Download Full-text

Surgical and Functional Outcomes on Omitting Cortical Renorrhaphy During Robot-Assisted Versus Laparoscopic Partial Nephrectomy: A Match-Paired Analysis

10.21203/rs.3.rs-1191585/v1 ◽

2022 ◽

Author(s):

Masashi Kubota ◽

Toshinari Yamasaki ◽

Shiori Murata ◽

Yohei Abe ◽

Yoichiro Tohi ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Surgical Margin ◽

Laparoscopic Partial Nephrectomy ◽

Robot Assisted ◽

Ischemic Time ◽

Warm Ischemic Time ◽

Estimated Blood Loss ◽

Preservation Rate

Abstract Objectives To assess surgical and functional outcomes in comparison of cortical renorrhaphy omitting, robot-assisted partial nephrectomy (CRO-RAPN), and laparoscopic partial nephrectomy (CRO-LPN). Methods Between July 2012 and June 2020, patients with localized clinical T1-2 renal masses who underwent CRO-RAPN or CRO-LPN were reviewed. The outcomes of the CRO-RAPN and CRO-LPN groups were compared using propensity score matching. Trifecta was defined as negative surgical margin, less than 25 minutes of warm ischemic time, and no complications of Clavien-Dindo grade III or more until three months postoperatively. Preservation rate of the estimated glomerular filtration rate (eGFR) was evaluated at six months postoperatively. Results A total of 291 patients, including 210 patients who underwent CRO-RAPN and 81 patients who underwent CRO-LPN, were included, and matched pairs of 150 patients were analyzed. The CRO-RAPN group was associated with a significantly shorter warm ischemic time (13 min vs 20 min, P < 0.001), shorter total operation time (162 min vs 212 min, P < 0.001), less estimated blood loss (40 mL vs 119 mL, P = 0.002), lower incidence of overall complications (3% vs 16%, P = 0.001), higher preservation rate of eGFR at six months postoperatively (93% vs 89%, P = 0.003), and higher trifecta achievement rate (84% vs 64%, P = 0.004) than the CRO-LPN group. Conclusions CRO-RAPN contributes to a shorter warm ischemic time, less blood loss, fewer complications, and preservation of renal function and makes it feasible to achieve a higher rate of trifecta compared to CRO-LPN.

Download Full-text

Percutaneous hook wire assistance during laparoscopic excision of an intrarenal mass

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0056 ◽

2019 ◽

Vol 101 (6) ◽

pp. e136-e138

Author(s):

C Kouriefs ◽

F Georgiades ◽

M Michaelides ◽

K Ioannides ◽

A Kouriefs ◽

...

Keyword(s):

Partial Nephrectomy ◽

Intraoperative Imaging ◽

Perioperative Complications ◽

Surgical Margin ◽

Laparoscopic Partial Nephrectomy ◽

Fuhrman Grade ◽

Estimated Blood Loss ◽

Renal Tumours ◽

Nephron Sparing ◽

Laparoscopic Excision

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.

Download Full-text

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.

Download Full-text

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

ISRN Oncology ◽

10.1155/2013/768647 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 1

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.

Download Full-text

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.

Download Full-text