open partial nephrectomy
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2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Syed Ali Ehsanullah ◽  
Abida Sultana ◽  
Brian Kelly ◽  
Charlotte Dunford ◽  
Zaheer Shah

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.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Kosuke Shibamori ◽  
Kohei Hashimoto ◽  
Tetsuya Shindo ◽  
Hidetoshi Tabata ◽  
Yuki Kyoda ◽  
...  

2021 ◽  
Author(s):  
Masaki Nakamura ◽  
Shuji Kameyama ◽  
Taro Teshima ◽  
Yasushi Inoue ◽  
Tadashi Yoshimatsu ◽  
...  

Abstract Background: There is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy.Therefore, this study aimed to clarify the chronological postoperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy.Methods: Clinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy were performed using a soft coagulation system. Perioperativeestimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery.Results: The median operation time was 122 minutes, and the median volume of estimated blood loss was155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Multivariate regression analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation at 5 days and 1 month after surgery, while age was an independent predictor of perioperative eGFR preservation at 3months after surgery.Conclusion: Chronological changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy have been reported.Ourresults could bea reference in the era of robot-assisted partial nephrectomy.


Author(s):  
Michael Staehler ◽  
S. Rodler ◽  
M. Schott ◽  
J. Casuscelli ◽  
C. Stief ◽  
...  

Abstract Purpose To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). Results Median age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). Conclusions Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A. Mukhtar A Mukhtar ◽  
B.A. Abdalaziz Alshareif ◽  
M. Yahia Ibrahim ◽  
M. Gareeballah Yousif Hijazi

Abstract Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.


2021 ◽  
Vol 8 ◽  
Author(s):  
Feng Yu ◽  
Qian Xu ◽  
Xian-Gen Liu

Objective: To analyze the impact of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) on outcomes of complex clear cell renal cell carcinoma (ccRCC).Methods: A total of 132 high-complex ccRCC patients with a Radius Exophytic Nearness Anterior Location (R.E.N.A.L) score ≥7 enrolled in our hospital between January 2018 and June 2020 were matched and assigned to an LPN group (given LPN treatment) and an OPN group (given OPN treatment), with 66 cases in each group. Two weeks and 3 months after the operation, the renal indexes, inflammatory factors, basic perioperative conditions, and incidence of complications were compared.Results: Two weeks after the operation, the levels of SCr and CysC were elevated, with higher levels observed in the LPN group (all P < 0.05), and the eGFR levels were reduced, with a lower result in the LPN group. Three months after the operation, the two groups observed decreased levels of SCr and CysC, and an increased level of eGFR; moreover, the decreased SCr and CysC levels were still higher, and the increased eGFR was lower than those before the operation (P < 0.05). The levels of CRP and TNF-α in the two groups increased after the operation, with a lower outcome in the LPN group (P < 0.05). Moreover, the LPN group had less intraoperative blood loss and shorter postoperative length of hospital stay but longer blocking time compared to the OPN group (P < 0.05). Patients in the LPN group were recorded with a lower complication incidence compared with the OPN group (3.03 vs. 15.15%, P < 0.05).Conclusion: Both LPN and OPN enjoy significant efficacy in the treatment of complex ccRCC and effectively protect renal function. Moreover, LPN is a more acceptable option for complex ccRCC due to its numerous benefits in postoperative stress response, complications, recovery. which is worthy of promotion with safety and feasibility.


2021 ◽  
pp. 116-123
Author(s):  
Mert Kılıç ◽  
Meftun Çulpan ◽  
Asıf Yıldırım ◽  
Turhan Çaşkurlu

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.


2021 ◽  
Vol 8 (2) ◽  
pp. 34-39
Author(s):  
Ahmed Al Asker ◽  
Abdulmalik Addar ◽  
Mohammed Alghamdi ◽  
Saud Alawad ◽  
Mohammed Alharbi ◽  
...  

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.


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