101
|
Zhang Z, Zhao J, Dong W, Remer E, Li J, Demirjian S, Zabell J, Campbell SC. Acute Kidney Injury after Partial Nephrectomy: Role of Parenchymal Mass Reduction and Ischemia and Impact on Subsequent Functional Recovery. Eur Urol 2015; 69:745-752. [PMID: 26525838 DOI: 10.1016/j.eururo.2015.10.023] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/08/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Acute increase of serum creatinine (SCr) after partial nephrectomy (PN) is primarily due to parenchymal mass reduction or ischemia; however, only ischemia can impact subsequent functional recovery. OBJECTIVE We evaluate etiologies of acute kidney injury (AKI) after PN and their prognostic significance. DESIGN, SETTING, AND PARTICIPANTS From 2007-2014, 83 solitary kidneys managed with PN had necessary studies for detailed analysis of function and parenchymal mass before/after surgery. AKI was classified by Risk/Injury/Failure/Loss/Endstage classification and defined by either standard criteria (comparison to preoperative SCr) or proposed criteria (comparison to projected postoperative SCr based on parenchymal mass reduction). Subsequent recovery was defined as percent function preserved/percent mass saved. INTERVENTION PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictive factors for AKI were evaluated by logistic regression. Relationship between AKI grade and subsequent functional recovery was assessed by linear regression. RESULTS AND LIMITATIONS Median duration warm ischemia (n=39) was 20 min and hypothermia (n=44) was 29 min. Median parenchymal mass reduction was 11%. AKI occurred in 45 patients based on standard criteria and 38 based on proposed criteria, and reflected injury/failure (grade = 2/3) in 23 and 16 patients, respectively. On multivariable analysis, only ischemia time associated with AKI occurrence (p=0.016). Based on the proposed criteria, median recovery from ischemia was 99% in patients without AKI and 95%/90%/88% for patients with grades 1/2/3 AKI, respectively. The coefficient for association between AKI grade based on proposed criteria and subsequent functional recovery was -4.168 (p=0.018). Main limitation is limited patient cohort. CONCLUSIONS Parenchymal mass reduction and ischemia both contribute to acute changes in SCr after PN. Classification of AKI by proposed criteria significantly associates with subsequent functional recovery. However, more robust numbers will be needed to further assess the merits of the proposed criteria. While AKI is associated with suboptimal recovery, even patients with grade 2/3 AKI reached 88-90% of recovery expected. PATIENT SUMMARY Acute decline in function after partial nephrectomy associates with more prolonged ischemia time, and appears to impact subsequent functional recovery. However, most kidneys eventually recover strongly, even if their function is sluggish in the first few days after surgery.
Collapse
Affiliation(s)
- Zhiling Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Juping Zhao
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Shanghai Jiao Tong University, School of Medicine, Ruijin Hospital, Department of Urology, Shanghai, China
| | - Wen Dong
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric Remer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Sevag Demirjian
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Zabell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
102
|
Ener K, Altınova S, Canda AE, Özcan MF, Asil E, Ürer E, Atmaca AF, Akbulut Z. Outcomes of robot-assisted laparoscopic transperitoneal pyeloplasty procedures: a series of 18 patients. Turk J Urol 2015; 40:193-8. [PMID: 26328177 DOI: 10.5152/tud.2014.33898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/24/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We evaluated outcomes of our robot-assisted laparoscopic transperitoneal pyeloplasty (RALP) procedures. MATERIAL AND METHODS Between July 2011 and March 2014, 18 RALP procedures were performed at our instutition. Ureteropelvic junction obstruction (UPJO) diagnosis was made based on clinical presentation and intravenous urography. All patients underwent basal and diuretic isotopic renography to evaluate the degree of obstruction and impaired renal function. Anderson-Hynes dismembered pyeloplasty technique was used with a transperitoneal approach by using the da Vinci-S 4-arm surgical robot. Outcomes were assessed retrospectively. RESULTS Mean patient age was 31.3±11.7 (13-62) years. Male: female ratio was 9: 9. All procedures were primary surgeries. Of 18 patients, 10 (55.5%) had a crossing vessel and 8 (44.5%) had intrinsic obstruction. Mean operative time was 150.4±17.2 (115-185) minutes. Mean anastomosis time was 21.4±5.5 (10-33) minutes. Mean blood loss during the operation was 33.6±17.3 (10-60) cc. Mean hospital stay was 2.6±1.0 (1-6) days. No conversion to open surgery was required. No intraoperative and perioperative (0-30 days) complication occurred. Readmission rate during perioperative period was 0%. Median follow-up was 16.6±10.3 (3-35) months. Postoperative intravenous urography and renography showed improved results in all cases. CONCLUSION Due to our experience, RALP is a safe and feasible minimally invasive approach in patients with UPJO with excellent surgical and functional outcomes.
Collapse
Affiliation(s)
- Kemal Ener
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Serkan Altınova
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Muhammet Fuat Özcan
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Erem Asil
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Emre Ürer
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ziya Akbulut
- Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
103
|
Kondo T, Takagi T, Morita S, Omae K, Hashimoto Y, Kobayashi H, Iizuka J, Yoshida K, Fukuda N, Tanabe K. Early unclamping might reduce the risk of renal artery pseudoaneurysm after robot-assisted laparoscopic partial nephrectomy. Int J Urol 2015; 22:1096-102. [PMID: 26307333 DOI: 10.1111/iju.12902] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/23/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the influence of the early unclamping technique on the risk of renal artery pseudoaneurysm during robot-assisted laparoscopic partial nephrectomy. METHODS From January 2013 to October 2014, 96 patients underwent robot-assisted laparoscopic partial nephrectomy for renal masses at Tokyo Women's Medical University Hospital, Tokyo, Japan. Computed tomography angiography was carried out 3-4 days after surgery. Early in the series, renal hilum was left unclamped and renorrhaphy was subsequently carried out (conventional unclamping technique). An early unclamping technique has been used since November 2013. RESULTS A total of 61 patients underwent robot-assisted laparoscopic partial nephrectomy with early unclamping, and 35 patients underwent robot-assisted laparoscopic partial nephrectomy with conventional unclamping. Ischemia time was significantly shorter in the early unclamping group (16.5 vs. 23.1 min; P < 0.01). The early unclamping group showed a significantly lower incidence of asymptomatic renal artery pseudoaneurysm relative to the conventional unclamping group (11.4% vs. 28.6%; P = 0.03). Multivariate analysis showed that the early unclamping technique was a significant independent factor in reducing the risk of renal artery pseudoaneurysm (hazard ratio 0.27; P = 0.01). CONCLUSIONS The present findings suggest that an early unclamping technique might reduce ischemic time and risk of renal artery pseudoaneurysm. The absence of arterial bleeding before renorrhaphy is likely to be a key step in preventing renal artery pseudoaneurysm during robot-assisted laparoscopic partial nephrectomy.
Collapse
Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Omae
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Norihiro Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
104
|
Predicting length of stay after robotic partial nephrectomy. Int Urol Nephrol 2015; 47:1321-5. [PMID: 26156732 DOI: 10.1007/s11255-015-1044-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/22/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To investigate factors predictive of length of stay (LOS) after robotic partial nephrectomy (RPN) in an effort to identify patients suitable for RPN with overnight stay at outpatient surgical facilities. MATERIALS AND METHODS Retrospective chart review of patients who underwent RPN at Memorial Sloan Kettering Cancer Center from January 2007 to July 2012 was conducted. Univariate and multivariate analyses were performed to identify the main predictors of LOS. The discrimination of the multivariate model was measured using the area under the curve (AUC); tenfold cross-validation was performed to correct for over-fit. RESULTS One hundred and eighty-six patients were included in the analysis; 84 (45 %) had LOS of ≤1 day (median LOS 2 day; interquartile range 1-2). On univariate analysis, preoperative variables associated with LOS > 1 included larger tumors (P < 0.0001), lower estimated glomerular filtration rate (P = 0.003), older age (P = 0.006), female gender (P = 0.035), and higher comorbidity score (P = 0.015); operative variables associated with LOS > 1 day included greater estimated blood loss (P < 0.0001) and longer operative (P < 0.0001) and ischemia (P < 0.0001) times. The AUC of the preoperative model was 0.61 (95 % CI 0.52-0.69) after tenfold cross-validation. CONCLUSIONS LOS after RPN is influenced by age, gender, medical comorbidities, and tumor size. However, when analyzed retrospectively, these factors had limited ability to predict LOS after RPN with sufficient accuracy to develop a prediction tool.
Collapse
|
105
|
Akca O, Zargar H, Attalla K, Brandao LF, Laydner H, Krishnan J, Stein RJ, Kaouk JH. Possible Detrimental Effects of Clamping Main Versus Segmental Renal Arteries for the Achievement of Renal Global Ischemia During Robot-Assisted Partial Nephrectomy. J Endourol 2015; 29:785-90. [DOI: 10.1089/end.2014.0834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kyrollis Attalla
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
106
|
Sharma N, Zhang Z, Mir MC, Takagi T, Bullen J, Campbell SC, Remer EM. Comparison of 2 Computed Tomography–based Methods to Estimate Preoperative and Postoperative Renal Parenchymal Volume and Correlation With Functional Changes After Partial Nephrectomy. Urology 2015; 86:80-6. [DOI: 10.1016/j.urology.2015.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/06/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
|
107
|
Affiliation(s)
- Justin B. Emtage
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
108
|
Zargar H, Akca O, Ramirez D, Brandao LF, Laydner H, Krishnan J, Stein RJ, Kaouk JH. The Impact of Extended Warm Ischemia Time on Late Renal Function After Robotic Partial Nephrectomy. J Endourol 2015; 29:444-8. [DOI: 10.1089/end.2014.0557] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Ramirez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
109
|
Robot-assisted laparoscopic partial nephrectomy in patients with previous abdominal surgery: single center experience. Int J Med Robot 2015; 11:389-94. [DOI: 10.1002/rcs.1633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/30/2014] [Accepted: 12/03/2014] [Indexed: 01/06/2023]
|
110
|
Omae K, Kondo T, Takagi T, Morita S, Hashimoto Y, Kobayashi H, Iizuka J, Nozaki T, Yoshida K, Tanabe K. Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy. Int J Urol 2015; 22:356-61. [PMID: 25581594 DOI: 10.1111/iju.12696] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate the incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by 3-D computed tomography arteriography in the early period after minimally invasive partial nephrectomy, including laparoscopic and robotic partial nephrectomy. METHODS From February 2012 to November 2013, 101 patients underwent minimally invasive partial nephrectomy for renal masses. Computed tomography arteriography was carried out 3-4 days after surgery; radiologists diagnosed renal artery pseudoaneurysm in a blinded manner. Factors influencing the occurrence of renal artery pseudoaneurysm were analyzed with the logistic regression model. RESULTS The incidence of renal artery pseudoaneurysm was unexpectedly high at 21.7% when detected by computed tomography arteriography during the early period after minimally invasive partial nephrectomy. The renal artery pseudoaneurysm group showed a significantly larger tumor size (P = 0.02), significantly higher N component score (P = 0.01) and higher incidence of renal sinus exposure or opening of the collecting system (P < 0.01) compared with the no renal artery pseudoaneurysm group. Although these aforementioned factors were found to be significant by univariate analysis, multivariate analysis showed that renal sinus exposure was the only significant independent predictive factor for occurrence of renal artery pseudoaneurysm. Tumor-related factors, such as the N component of the nephrometry scoring system or tumor size, did not show an independent influence on the occurrence of renal artery pseudoaneurysm. CONCLUSIONS The present study shows an unexpectedly high incidence of asymptomatic unruptured renal artery pseudoaneurysm detected by computed tomography arteriography in the early period after minimally invasive partial nephrectomy. Renal sinus exposure is an independent significant factor predicting the occurrence of renal artery pseudoaneurysm. Avoidance of deep excision into the renal sinus could reduce the risk of renal artery pseudoaneurysm.
Collapse
Affiliation(s)
- Kenji Omae
- Departments of Urology, Tokyo Women's Medical University
| | | | | | | | | | | | | | | | | | | |
Collapse
|
111
|
Cost comparison of open and robotic partial nephrectomy using a short postoperative pathway. Urology 2015; 85:596-603. [PMID: 25586478 DOI: 10.1016/j.urology.2014.10.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/06/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare immediate perioperative direct costs of open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN), managed under a common care pathway. METHODS Retrospective review of detailed institutional cost data for patients treated with OPN and RPN during 2011 was conducted. Cost and clinical data of OPN and RPN were compared for all patients and for patients stratified by length of stay (LOS), American Society of Anesthesiologists (ASA), and RENAL nephrometry scores. RESULTS The study cohort included 190 OPN and 63 RPN cases. OPN was associated with higher ASA scores (P <.001), shorter operative times (P = .014), and higher estimated blood loss (P <.001). Median (interquartile range) LOS was 2 days (2-3 days) for OPN compared with 1 day (1-2 days) for RPN (P <.001). Median perioperative cost of OPN was lower than that of RPN with a difference of $3091 (P <.001). Although hospitalization costs were higher in OPN, surgical costs were higher in RPN ($854 and $3695 difference in median costs, respectively; P <.001 for both). The total cost of OPN for patients with an above-average LOS remained lower than that of RPN ($2680 difference in median costs; P = .001). RPN costs remained significantly higher when stratifying patients by their ASA and RENAL nephrometry scores. CONCLUSION Despite the shorter hospital LOS associated with RPN, the immediate perioperative cost of OPN was lower than that of RPN for patients managed under a common care pathway, mainly due to high robotic purchase and maintenance costs. In light of the current health care debate, such financial disincentives may compromise the sustainability of advances in medical technology.
Collapse
|
112
|
Zargar H, Akca O, Autorino R, Brandao LF, Laydner H, Krishnan J, Samarasekera D, Stein RJ, Kaouk JH. Ipsilateral renal function preservation after robot-assisted partial nephrectomy (RAPN): an objective analysis using mercapto-acetyltriglycine (MAG3) renal scan data and volumetric assessment. BJU Int 2014; 115:787-95. [DOI: 10.1111/bju.12825] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Homayoun Zargar
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Oktay Akca
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Riccardo Autorino
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Luis Felipe Brandao
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Humberto Laydner
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Dinesh Samarasekera
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Robert J. Stein
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| |
Collapse
|
113
|
Zargar H, Khalifeh A, Autorino R, Akca O, Brandao LF, Laydner H, Krishnan J, Samarasekera D, Haber GP, Stein RJ, Kaouk JH. Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization. Int Braz J Urol 2014; 40:763-71. [DOI: 10.1590/s1677-5538.ibju.2014.06.07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/06/2014] [Indexed: 12/17/2022] Open
|
114
|
Robot-assisted Laparoscopic Adrenalectomy: Step-by-Step Technique and Comparative Outcomes. Eur Urol 2014; 66:898-905. [DOI: 10.1016/j.eururo.2014.04.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/08/2014] [Indexed: 11/23/2022]
|
115
|
Zargar H, Bhayani S, Allaf ME, Stifelman M, Rogers C, Larson J, Ball MW, Marshall S, Kumar R, Fergany A, Campbell S, Kaouk J. Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney. J Endourol 2014; 28:1224-30. [DOI: 10.1089/end.2014.0297] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sam Bhayani
- Washington University School of Medicine, Department of Urology, St. Louis, Missouri
| | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Stifelman
- New York University School of Medicine, Department of Urology, New York, New York
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey Larson
- Washington University School of Medicine, Department of Urology, St. Louis, Missouri
| | - Mark W. Ball
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susan Marshall
- New York University School of Medicine, Department of Urology, New York, New York
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Amr Fergany
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
116
|
Akca O, Kaouk JH, Zargar H, Brandao LF, Haber GP, Autorino R, Stein RJ. Robot assisted heminephrectomy for duplicated renal collecting system: technique and outcomes. Int J Med Robot 2014; 11:126-9. [DOI: 10.1002/rcs.1607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/09/2014] [Accepted: 07/10/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Oktay Akca
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | - Homayoun Zargar
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | - Luis F. Brandao
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | - Riccardo Autorino
- Center for Laparoscopic and Robotic Surgery; Glickman Urologic & Kidney Institute, Cleveland Clinic; Cleveland OH USA
| | | |
Collapse
|
117
|
30-Day Hospital Readmission after Robotic Partial Nephrectomy—Are We Prepared for Medicare Readmission Reduction Program? J Urol 2014; 192:677-81. [DOI: 10.1016/j.juro.2014.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 01/20/2023]
|
118
|
Kaouk JH, Samarasekera D, Krishnan J, Autorino R, Acka O, Brando LF, Laydner H, Zargar H. Robotic Partial Nephrectomy With Intracorporeal Renal Hypothermia Using Ice Slush. Urology 2014; 84:712-8. [DOI: 10.1016/j.urology.2014.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/21/2014] [Accepted: 05/05/2014] [Indexed: 12/20/2022]
|
119
|
Migration massive de clips Hem-o-lok® après néphrectomie partielle ouverte : cas clinique et revue de la littérature. Prog Urol 2014; 24:616-9. [DOI: 10.1016/j.purol.2014.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/08/2014] [Accepted: 05/04/2014] [Indexed: 11/21/2022]
|
120
|
Kaouk JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 2014; 66:1033-43. [PMID: 25041850 DOI: 10.1016/j.eururo.2014.06.039] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. OBJECTIVE To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. DESIGN, SETTING, AND PARTICIPANTS This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. INTERVENTION Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. RESULTS AND LIMITATIONS A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. CONCLUSIONS We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. PATIENT SUMMARY A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. TRIAL REGISTRATION The study was registered on www.ClinicalTrials.gov (NCT02136121).
Collapse
Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Adil Ouzzane
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Vincent Flamand
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Arnauld Villers
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| |
Collapse
|
121
|
Autorino R, Zargar H, Kaouk JH. Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil Steril 2014; 102:939-49. [PMID: 24993800 DOI: 10.1016/j.fertnstert.2014.05.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/08/2014] [Accepted: 05/21/2014] [Indexed: 12/11/2022]
Abstract
The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology.
Collapse
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
122
|
Brandao LF, Zargar H, Autorino R, Akca O, Laydner H, Samarasekera D, Krishnan J, Haber GP, Stein RJ, Kaouk JH. Robot-assisted partial nephrectomy for ≥ 7 cm renal masses: a comparative outcome analysis. Urology 2014; 84:602-8. [PMID: 24929947 DOI: 10.1016/j.urology.2014.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present our robotic partial nephrectomy (RPN) experience for renal masses ≥ 7 cm and compare the surgical outcomes in this cohort with those obtained for small (≤ 4 cm) renal masses. MATERIALS AND METHODS We retrospectively reviewed our institutional review board-approved RPN database and identified patients undergoing RPN for tumors ≥ 7 cm. Surgical technique, renal function, oncologic, and pathologic data were analyzed and compared with the RPN for renal masses ≤ 4 cm. RESULTS Overall, 441 patients were identified for the purpose of this study, including 29 cases and 412 controls. Median operative time (200 vs 180 min; P = .005), warm ischemia time (26.5 vs 19 min; P <.001), and estimated blood loss (250 mL [353] vs 150 mL [150]; P <.001) were significantly lower in the control group. Postoperative complications were significantly higher in the case group (37.9% vs 15.8%; P = .005). However, the percentages of major complications (Clavien grade ≥ III) were comparable (18.2% vs 17%; P = .57 for cases and controls respectively). Postoperative blood transfusion was higher for larger tumor group (24.1% vs 4.1%; P <.001). Positive margins were similar between groups (5.9% vs 3.3%; P = .45 for cases and controls respectively). There was no difference in estimated glomerular filtration rate decline between the two groups (12.2% vs 15.8% decline; P = .98). CONCLUSION RPN represents a feasible and safe nephron-sparing surgery approach for highly selected (mostly exophytic growth pattern, polar location, and likelihood of benign histology) renal masses ≥ 7 cm in diameter.
Collapse
Affiliation(s)
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, OH
| | | | - Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, OH
| | | | | | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, OH
| | | | - Robert J Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, OH
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
| |
Collapse
|
123
|
Akca O, Zargar H, Autorino R, Brandao LF, Laydner H, Krishnan J, Samarasekera D, Li J, Haber GP, Stein R, Kaouk JH. Robotic partial nephrectomy for cystic renal masses: a comparative analysis of a matched-paired cohort. Urology 2014; 84:93-8. [PMID: 24821467 DOI: 10.1016/j.urology.2014.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the outcomes of robotic partial nephrectomy (RPN) for cystic and solid renal neoplasms. METHODS Our RPN database was queried to identify consecutive patients who underwent RPN for cystic and solid renal masses in the period between July 2007 and July 2013. Cystic renal masses were diagnosed on cross-sectional imaging (computed tomography or magnetic resonance imaging). Matching was done between the patients with cystic renal masses and patients with solid renal masses (1:1 matching) by age, gender, tumor size, and nephrometry score. RESULTS Of 647 cases, 55 patients with cystic masses (group 1) were matched with 55 patients with solid tumors (group 2). There was no cyst rupture or positive surgical margin observed in group 1. The volume of resected rim of healthy renal parenchyma surrounding the tumor was the same for both groups (P=.9). There was no difference between the groups in terms of percentage of glomerular filtration rate preservation postoperatively (85% vs 86%; P=.94). There was no difference in term of overall complications between the 2 groups. Thirty patients (54.5%) in group 1 and 47 patients (85.5%) in group 2 had renal cell carcinoma (P=.0001). CONCLUSION RPN can be safely and effectively performed when treating a suspicious cystic renal neoplasm with outcomes resembling those obtained for solid masses. Thus, when a cystic renal mass in encountered, nephron-sparing surgery can be offered and RPN represents an effective tool for this approach.
Collapse
Affiliation(s)
- Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Jianbo Li
- Quantitative Health Service, Cleveland Clinic, Cleveland, OH
| | | | - Robert Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
124
|
Wahafu W, Ma X, Li HZ, Ding Q, Wang BJ, Shi TP, Zheng T, Dong J, Cai W, Zhang X. Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: single-surgeon series. Int J Urol 2014; 21:865-73. [PMID: 24780100 DOI: 10.1111/iju.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate renorrhaphy techniques and to analyze surgical outcomes in retroperitoneal laparoscopic partial nephrectomy. METHODS A retrospective study from January 2008 to December 2011 analyzed 526 patients with renal tumors in whom renorrhaphy was changed from one layer, interrupted, figure-of-eight (n = 228) suture to two layers, continuous, unknotted (n = 298) suture. All procedures were carried out by the same laparoscopic surgeon (XZ). Patient demographics, tumor characteristics, operative outcomes and perioperative renal function were compared. RESULTS Median follow up for one layer, interrupted, figure-of-eight suture and two layers, continuous, unknotted suture was 31 and 28 months, respectively. The two layers, continuous, unknotted suture group had shorter warm ischemia time (P = 0.021), faster removal of Jackson-Pratt drains (P = 0.029) and shorter hospital stay (P = 0.037) than the one layer, interrupted, figure-of-eight suture group. There was a trend towards a better preservation of glomerular filtration rates in the two layers, continuous, unknotted suture group (P = 0.045). In a multivariable model, the two layers, continuous, unknotted suture technique was a statistically significant independent predictor of warm ischemia time (P = 0.01), hospital stay (P = 0.001) and estimated glomerular filtration rates (P = 0.043). CONCLUSIONS Two layers, continuous, unknotted suture renorrhaphy allows better outcomes than one layer, interrupted, figure-of-eight suture renorrhaphy in retroperitoneal laparoscopic partial nephrectomy. A longer clinical follow-up evaluation is warranted.
Collapse
Affiliation(s)
- Wasilijiang Wahafu
- Department of Urology, Military Postgraduate Medical College, Chinese People's Liberation Army General Hospital, Beijing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
125
|
Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS One 2014; 9:e94878. [PMID: 24740259 PMCID: PMC3989253 DOI: 10.1371/journal.pone.0094878] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/18/2014] [Indexed: 01/30/2023] Open
Abstract
Objectives To critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). Materials and Methods A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot. Results Eight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39–67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42–0.67; p<0.00001), shorter hospital stay (WMD: −2.78; 95%CI, −3.36 to −1.92; p<0.00001), less estimated blood loss(WMD: −106.83; 95%CI, −176.4 to −37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies. Conclusions RPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings.
Collapse
|
126
|
Akca O, Zargar H, Autorino R, Brandao LF, Laydner H, Samarasekera D, Krishnan J, Noble M, Haber GP, Kaouk JH, Stein RJ. Robotic partial nephrectomy for caliceal diverticulum: a single-center case series. J Endourol 2014; 28:958-61. [PMID: 24720868 DOI: 10.1089/end.2014.0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The aim of this study is to examine the role of robotic partial nephrectomy (RPN) in the management of caliceal diverticula by assessing our single-center outcomes. Between July 2007 and July 2013, 7 of 670 patients underwent RPN procedures as a reason of caliceal diverticula. The indications for RPN in all cases were recurrent urinary tract infection and pain attributed to the diverticulum in addition to failed management by endourologic or extracorporeal shockwave lithotripsy (SWL) treatments. One patient with a calcified diverticulum and another with an unsuccessful SWL treatment underwent RPN without further endourologic intervention. The other five patients had a history of unsuccessful percutaneous nephrolithotomy (one case), ureteroscopy (URS) (two cases), and a combination of SWL+URS (two cases). No intraoperative or postoperative complications were observed. No patient was readmitted postoperatively. Unique features of the robotic platform facilitate the excision of diverticulum and subsequent kidney reconstruction for this benign, but complex pathology.
Collapse
Affiliation(s)
- Oktay Akca
- Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
127
|
Furukawa J, Miyake H, Tanaka K, Sugimoto M, Fujisawa M. Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases. Int J Med Robot 2014; 10:385-90. [DOI: 10.1002/rcs.1574] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/26/2013] [Accepted: 01/02/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Junya Furukawa
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Hideaki Miyake
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Kazushi Tanaka
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Maki Sugimoto
- Division of Gastroenterology; Kobe University Graduate School of Medicine; Japan
| | - Masato Fujisawa
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| |
Collapse
|
128
|
Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R, Stein RJ, Haber GP, Kaouk JH. Robot-assisted partial nephrectomy (RAPN) for completely endophytic renal masses: a single institution experience. BJU Int 2014; 113:762-8. [DOI: 10.1111/bju.12455] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Ali Khalifeh
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Humberto Laydner
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Dinesh Samarasekera
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Emad Rizkala
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Remi Eyraud
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Robert J. Stein
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| |
Collapse
|
129
|
Salami SS, George AK, Rais-Bahrami S, Okhunov Z, Waingankar N, Kavoussi LR. Off-Clamp Laparoscopic Partial Nephrectomy for Hilar Tumors: Oncologic and Renal Functional Outcomes. J Endourol 2014; 28:191-5. [DOI: 10.1089/end.2013.0440] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Simpa Samuel Salami
- The Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, New Hyde Park, New York
| | - Arvin Koruthu George
- The Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, New Hyde Park, New York
| | - Soroush Rais-Bahrami
- The Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, New Hyde Park, New York
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Irvine, California
| | - Nikhil Waingankar
- The Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, New Hyde Park, New York
| | - Louis Raphael Kavoussi
- The Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, New Hyde Park, New York
| |
Collapse
|
130
|
Figenshau S. Editorial comment for Salami et al. J Endourol 2013; 28:195. [PMID: 24345008 DOI: 10.1089/end.2013.0713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sherb Figenshau
- Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| |
Collapse
|
131
|
Ploussard G, Haddad R, Kovac E, Richard P, Anidjar M, Bladou F. Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience. Can Urol Assoc J 2013; 7:348-54. [PMID: 24319515 DOI: 10.5489/cuaj.753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. METHODS Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. RESULTS The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure. INTERPRETATION RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.
Collapse
Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC
| | | | | | | | | | | |
Collapse
|
132
|
Khalifeh A, Kaouk JH, Bhayani S, Rogers C, Stifelman M, Tanagho YS, Kumar R, Gorin MA, Sivarajan G, Samarasekera D, Allaf ME. Positive Surgical Margins in Robot-Assisted Partial Nephrectomy: A Multi-Institutional Analysis of Oncologic Outcomes (Leave No Tumor Behind). J Urol 2013; 190:1674-9. [DOI: 10.1016/j.juro.2013.05.110] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Ali Khalifeh
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sam Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Michael Stifelman
- Department of Urology, New York University, Langone Medical Center, New York, New York
| | - Youssef S. Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Michael A. Gorin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ganesh Sivarajan
- Department of Urology, New York University, Langone Medical Center, New York, New York
| | - Dinesh Samarasekera
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
133
|
Rizkala ER, Khalifeh A, Autorino R, Samarasekera D, Laydner H, Kaouk JH. Zero ischemia robotic partial nephrectomy: sequential preplaced suture renorrhaphy technique. Urology 2013; 82:100-4. [PMID: 23806396 DOI: 10.1016/j.urology.2013.03.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a robotic partial nephrectomy (PN) technique that eliminates renal global ischemia while decreasing parenchymal bleeding. METHODS Before tumor resection, a suture is placed through the parenchyma adjacent to the tumor and deep to the planned edge of resection. The tumor resection is begun between the tumor edge and the preplaced suture and continued along the excision margin until some bleeding is encountered. A second suture is placed into the already excised parenchyma. This is repeated until the mass is completely excised, while suturing the parenchyma simultaneously. RESULTS Fourteen patients underwent this technique between April 2008 and January 2013 by a single surgeon. Median age was 66 years and 64.3% (N = 9) were men. Median body mass index (BMI) was 27.5 Kg/m(2). Median radius, endophytic, nearness to collecting system, anterior/posterior, and location (RENAL) nephrometry score was 6.5. Median tumor size excised off clamp was 2.2 cm. Three patients had multiple tumors; 2 having a warm ischemia time (WIT) of 14.5 and 15 minutes. Median estimated blood loss (EBL) was 192.5 mL. Median operative time was 160 minutes. There were no Clavien grade 3 or 4 complications. One patient had a postoperative ileus and 1 patient had a blood transfusion and deep vein thrombosis. One patient had a positive tumor parenchymal margin, but negative excisional bed margin. Median hospital stay was 3 days and median follow-up was 8.4 months. CONCLUSION Sequential preplaced suture renorrhaphy technique is a safe and effective technique that may be useful in renal function preservation by limiting or eliminating WIT while aiding in maximizing nephron preservation, especially in those patients with solitary kidneys and multiple tumors.
Collapse
Affiliation(s)
- Emad R Rizkala
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | |
Collapse
|
134
|
Manny TB, Pompeo AS, Hemal AK. Robotic partial adrenalectomy using indocyanine green dye with near-infrared imaging: the initial clinical experience. Urology 2013; 82:738-42. [PMID: 23859531 DOI: 10.1016/j.urology.2013.03.074] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To present the initial clinical experience with robot-assisted partial adrenalectomy using indocyanine green dye with near-infrared fluorescence (ICG-NIRF) imaging. METHODS Three consecutive patients with solitary adrenal masses with worrisome features were referred for treatment. The preoperative workup included dedicated axial imaging and adrenal function studies. All patients underwent purely robotic partial adrenalectomy with ICG-NIRF guidance. Relevant steps of the technique included a transperitoneal approach, gross identification of the adrenal gland, administration of 5 mg intravenous ICG, and finally, mass resection guided by ICG-NIRF and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. RESULTS Robotic partial adrenalectomy was successfully performed with negative margins in all patients. All masses were hypofluorescent relative to normal adrenal tissue with ICG-NIRF and included a pheochromocytoma, lipoadenoma, and follicular lymphoid hyperplasia. CONCLUSION Robotic partial adrenalectomy with intraoperative ICG-NIRF is safe and feasible. The addition of ICG-NIRF may help mass identification, excision, and promote the use adrenal-sparing surgery.
Collapse
Affiliation(s)
- Ted B Manny
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | | |
Collapse
|
135
|
Krane LS, Manny TB, Mufarrij PW, Hemal AK. Does experience in creating a robot-assisted partial nephrectomy (RAPN) programme in an academic centre impact outcomes or complication rate? BJU Int 2013; 112:207-15. [DOI: 10.1111/bju.12160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- L. Spencer Krane
- Department of Urology; Wake Forest University; Winston-Salem; NC; USA
| | - Theodore B. Manny
- Department of Urology; Wake Forest University; Winston-Salem; NC; USA
| | | | - Ashok K. Hemal
- Department of Urology; Wake Forest University; Winston-Salem; NC; USA
| |
Collapse
|
136
|
Autorino R, De Sio M. Editorial comment to "Clinical analysis of the PADUA and the RENAL scoring systems for renal neoplasms: a retrospective study of 245 patients undergoing laparoscopic partial nephrectomy". Int J Urol 2013; 21:44-5. [PMID: 23710542 DOI: 10.1111/iju.12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA; Urology Service, Second University of Naples, Naples, Italy. ,
| | | |
Collapse
|
137
|
Merseburger AS, Herrmann TRW, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN. EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013; 64:277-91. [PMID: 23764016 DOI: 10.1016/j.eururo.2013.05.034] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
CONTEXT This is a short version of the European Association of Urology (EAU) guidelines on robotic and single-site surgery in urology, as created in 2013 by the EAU Guidelines Office Panel on Urological Technologies. OBJECTIVE To evaluate current evidence regarding robotic and single-site surgery in urology and to provide clinical recommendations. EVIDENCE ACQUISITION A comprehensive online systematic search of the literature according to Cochrane recommendations was performed in July 2012, identifying data from 1990 to 2012 regarding robotic and single-site surgery in urology. EVIDENCE SYNTHESIS There is a lack of high-quality data on both robotic and single-site surgery for most upper and lower urinary tract operations. Mature evidence including midterm follow-up data exists only for robot-assisted radical prostatectomy. In the absence of high-quality data, the guidelines panel's recommendations were based mostly on the review of low-level evidence and expert opinions. CONCLUSIONS Robot-assisted urologic surgery is an emerging and safe technology for most urologic operations. Further documentation including long-term oncologic and functional outcomes is deemed necessary before definite conclusions can be drawn regarding the superiority or not of robotic assistance compared with the conventional laparoscopic and open approaches. Laparoendoscopic single-site surgery is a novel laparoscopic technique providing a potentially superior cosmetic outcome over conventional laparoscopy. Nevertheless, further advantages offered by this technology are still under discussion and not yet proven. Due to the technically demanding character of the single-site approach, only experienced laparoscopic surgeons should attempt this technique in clinical settings. PATIENT SUMMARY This work represents the shortened version of the 2013 European Association of Urology guidelines on robotic and single-site surgery. The authors systematically evaluated published evidence in these fields and concluded that robotic assisted surgery is possible and safe for most urologic operations. Whilst laparoendoscopic single-site surgery is performed using the fewest incisions, the balance between risk and benefit is currently unclear. The evidence to support the conclusions in this guideline was generally poor, but best for robotic assisted radical prostatectomy. As such, these recommendations were based upon expert opinion, and further high-quality research is needed in this field.
Collapse
Affiliation(s)
- Axel S Merseburger
- Department of Urology and Urologic Oncology Medical School of Hanover (MHH), Hanover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
138
|
Samarasekera D, Autorino R, Khalifeh A, Kaouk JH. Robot-assisted laparoscopic renal artery aneurysm repair with selective arterial clamping. Int J Urol 2013; 21:114-6. [DOI: 10.1111/iju.12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Dinesh Samarasekera
- Cleveland Clinic; Glickman Urologic and Kidney Institute; Cleveland Ohio USA
| | - Riccardo Autorino
- Cleveland Clinic; Glickman Urologic and Kidney Institute; Cleveland Ohio USA
| | - Ali Khalifeh
- Cleveland Clinic; Glickman Urologic and Kidney Institute; Cleveland Ohio USA
| | - Jihad H Kaouk
- Cleveland Clinic; Glickman Urologic and Kidney Institute; Cleveland Ohio USA
| |
Collapse
|
139
|
Wang L, Lee BR. Robotic partial nephrectomy: current technique and outcomes. Int J Urol 2013; 20:848-59. [PMID: 23635467 DOI: 10.1111/iju.12177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/21/2013] [Indexed: 01/20/2023]
Abstract
Over the past decade, management of the T1 renal mass has focused on nephron-sparing surgery. Robotic partial nephrectomy has played an increasing role in the technique of preserving renal function by decreasing warm ischemia time, as well as optimizing outcomes of hemorrhage and fistula. Robot-assisted partial nephrectomy is designed to provide a minimally-invasive nephron-sparing surgical option utilizing reconstructive capability, decreasing intracorporeal suturing time, technical feasibility and safety. Ultimately, its benefits are resulting in its dissemination across institutions. Articulated instrumentation and three-dimensional vision facilitate resection, collecting system reconstruction and renorrhaphy, leading to decreased warm ischemia time while preserving oncological outcomes. The aim of the present review was to present our surgical sequence and technique, as well as review the current status of robot-assisted partial nephrectomy.
Collapse
Affiliation(s)
- Liang Wang
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | | |
Collapse
|
140
|
Matsuda T. Recent advances in urologic laparoscopic surgeries: laparoendoscopic single-site surgery, natural orifice transluminal endoscopic surgery, robotics and navigation. Asian J Endosc Surg 2013; 6:68-77. [PMID: 23601994 DOI: 10.1111/ases.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/26/2013] [Accepted: 03/05/2013] [Indexed: 12/17/2022]
Abstract
Laparoscopic surgery was developed at the end of the 1980s and has been utilized in almost all urologic surgical procedures. It offers the benefits of less invasiveness and earlier recovery than open surgery. The introduction of laparoendoscopic single-site surgery has offered reduced pain and improved cosmetic satisfaction to patients. Scarless nephrectomy has been realized with transvaginal natural orifice transluminal endoscopic surgery in women. The development of surgical robots has decreased the technical difficulty of complicated procedures, shortened the learning curve, and improved perioperative outcomes relative to laparoscopic surgery. Surgical navigation using real-time sonography, augmented reality, fluorescence, or radioisotope images will improve the quality of these surgeries.
Collapse
Affiliation(s)
- Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010, Japan.
| |
Collapse
|
141
|
Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R, Haber GP, Stein RJ, Kaouk JH. Repeat robot-assisted partial nephrectomy (RAPN): feasibility and early outcomes. BJU Int 2013; 111:767-72. [DOI: 10.1111/j.1464-410x.2013.11800.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Riccardo Autorino
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Ali Khalifeh
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Humberto Laydner
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Dinesh Samarasekera
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Emad Rizkala
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Remi Eyraud
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Robert J. Stein
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| | - Jihad H. Kaouk
- Center for Laparoscopic and Robotic Surgery; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland; OH; USA
| |
Collapse
|
142
|
Khalifeh A, Autorino R, Eyraud R, Samarasekera D, Laydner H, Panumatrassamee K, Stein RJ, Kaouk JH. Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. Eur Urol 2013; 64:744-50. [PMID: 23639721 DOI: 10.1016/j.eururo.2013.03.052] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/25/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND With the wider adoption of minimally invasive partial nephrectomy (PN), intermediate- and long-term outcomes data are needed to make firm conclusions about oncologic and functional efficacy, especially for robot-assisted PN (RPN). OBJECTIVE To report intermediate-term oncologic and renal functional outcomes of RPN. DESIGN, SETTING, AND PARTICIPANTS We performed a chart review of patients who had undergone RPN since June 2006; patients with a minimum of 2 yr of follow-up were included in this study. Length of follow-up was calculated from the date of surgery to the date of last clinical follow-up. Patients who were either lost to follow-up or who had follow-up outside of our center were sent surveys. INTERVENTION Transperitoneal RPN with or without hilar clamping. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The demographic, preoperative, and postoperative data were statistically analyzed. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), and cancer-free survival (CFS). Upstaging of chronic kidney disease (CKD) was calculated, as well. Univariate and multivariate analyses were performed to show predicting factors for the latest estimated glomerular filtration rate (eGFR). RESULTS AND LIMITATIONS Of 427 patients, 134 had a minimum follow-up of 2 yr, and 70 had a minimum of 3-6 yr of follow-up. The mean age was 59.1±12.5 yr, body mass index (BMI) was 29.8±6.2 kg/m(2), and Charlson comorbidity index (CCI) score was 4.2±1.6. The mean tumor size on computed tomography (CT) scan was 3.0±1.6 cm, RENAL score was 7.2±1.8, estimated blood loss (EBL) was 270.7±291.9 ml, operative time was 189.1±54.8 min, and warm ischemia time (WIT) was 17.9±10.3 min. A total of two intraoperative complications (1.5%) and five high-grade Clavien complications (3.7%) occurred. Patients stayed on average for 3.7±1.7 d in the hospital, and the average follow-up was 3.0±0.9 yr. OS was 97.01% at 3 yr and 90.20% at 5 yr; CFS was 98.92% at 3 yr and 98.92% at 5 yr; and CSS was 99.04%, as projected by the Kaplan-Meier method. The mean preoperative GFR was 88.2±0.8 ml/min per 1.73 m(2); the latest postoperative GFR was 80±24 ml/min per 1.73 m(2), with a 8±17.4% change. There was a 20.2% upstaging of CKD postoperatively, but no patients started dialysis. CONCLUSIONS This study reaffirms that RPN is effective in renal function preservation and oncologic control at an intermediate follow-up interval.
Collapse
Affiliation(s)
- Ali Khalifeh
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | |
Collapse
|
143
|
|