Open versus robot-assisted partial nephrectomy for highly complex renal masses: a meta-analysis of perioperitive and functional outcomes

Development and Internal Validation of a Novel Nomogram to Predict the Risk of Postoperative Acute Kidney Injury Following Robot-Assisted Partial Nephrectomy

OBJECTIVES

To develop a predictive tool to assist in predicting the risk of Acute Kidney Injury (AKI) following robot-assisted partial nephrectomy (RAPN).

METHODS

A retrospective review was performed on the prospectively maintained, IRB-approved database to identify all consecutive patients who underwent RAPN between 2008 and 2023. Patients with end-stage kidney disease (ESKD), horseshoe kidneys, solitary kidneys, and previous renal transplant recipients were excluded. AKI was defined according to the RIFLE (Risk, Injury, Failure, Loss, ESKD) Classification. A nomogram was constructed based on the multivariate logistic regression model comprising the different baseline clinicodemographic and renal tumor characteristics.

RESULTS

Of the 1927 patients included in our series, postoperative AKI was identified in 94 cases (4.9%). On multivariate regression analysis, several variables were identified as significant predictors of AKI, including female gender, African American ethnicity, higher body mass index, higher comorbidity burden, lower preoperative renal function, and renal tumors of higher complexity. Upon internal validation, the model demonstrated strong predictive performance. Long-term follow-ups of at least 5 years were available for 759 patients, with postoperative AKI identified to significantly contribute to the 5-year risk of kidney disease progression (OR 2.513; 95% CI 1.070-6.164, p=0.036).

CONCLUSION

In this study, we have developed a predictive model to predict the risk of postoperative AKI following RAPN based on the baseline preoperative characteristics. The nomogram can provide a valuable tool to identify at-risk patients, hence allowing surgeons to better select appropriate surgical candidates and consider treatment options that best optimize long-term functional outcomes while still ensuring a satisfactory oncological outcome.

The clinical application value of mixed reality in robotic laparoscopic partial nephrectomy

Purpose

Robot-assisted laparoscopic partial nephrectomy (RAPN) has become a key technology in the treatment of renal tumors. Effective preoperative planning and precise intraoperative navigation are critical to a successful surgical outcome. This study aimed to evaluate the clinical application value of mixed reality (MR) in robotic nephron-sparing partial nephrectomy for patients with renal tumors of different complexity based on the R.E.N.A.L. score.

Patients and methods

A retrospective analysis was conducted on 68 eligible patients with renal cancer who underwent RAPN at The Second Affiliated Hospital of Nanchang University from January 2021 to December 2023, with postoperative pathology confirmation. Patients were divided into two groups: the MR group, with 28 cases, and the traditional imaging (control) group, with 40 cases. All patients underwent mid-abdominal CT plain scans and enhancements. The MR group utilized three-dimensional reconstruction of CT data and employed 3D tablets and HoloLens glasses for preoperative discussions, surgical planning, and intraoperative guidance. Collect clinical data and metrics to assess surgical outcomes, as well as evaluate performance in areas such as preoperative discussions, doctor-patient communication, surgical planning, and intraoperative navigation.

Results

Compared to robot-assisted partial nephrectomy in the control group, the MR group experienced a reduction in operation time by approximately 30 min [(135.89 ± 23.494) min vs. (165.00 ± 34.320) min, P< 0.001)] and a decrease in ischemia time by around 2.5 min [(20.36 ± 3.956) min vs. (23.80± 6.889) min, P = 0.02)]. Within the subgroup with a R.E.N.A.L. score of less than 7 points, the MR group only showed a significant reduction in operation time [(134.55 ± 150.190) min vs. (150.19 ± 28.638) min, P = 0.045], with no notable differences in other parameters. For the subgroup with a R.E.N.A.L. score of 7 points or higher, the MR group exhibited shorter operation time [(140.83 ± 25.183) min vs. (195.77 ± 23.080) min, P< 0.001] and reduced warm ischemia time [(21.17 ± 2.714) min vs. (28.85 ± 7.570) min, P = 0.029]. Additionally, there was less estimated blood loss [(53.33 ± 5.164) min vs. (114.62 ± 80.376) min, P = 0.018]. All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.

Conclusion

In comparison to traditional RAPN, MR technology demonstrates the ability to decrease operation time and warm ischemia time all the while maintaining equivalent curative outcomes. Additionally, it enhances preoperative discussions, doctor-patient interactions, preoperative strategizing, and intraoperative navigation, particularly excelling in complex renal tumor cases of RAPN, where its benefits are most pronounced.

The rise of the machines: are robots the future of renal artery aneurysm repair? A systematic review

Renal artery aneurysms (RAAs) are a rare vascular condition. Robot-assisted surgery offers a minimally invasive approach for RAA repair, potentially improving surgical outcomes. This review investigates the current evidence on the effectiveness and limitations of this technique. A systematic search following PRISMA guidelines identified relevant studies across five electronic databases. Studies investigating the use of robot-assisted surgery for RAA repair were included. The review identified 11 studies encompassing a total of 23 patients. Procedures included aneurysmectomy, end-to-end anastomosis, prosthetic graft repair, and even coil embolization. All surgeries were successful, with only minor complications reported in four cases. Robot-assisted RAA repair shows promise as a minimally invasive approach with encouraging preliminary outcomes. However, the limited data come from small studies. Future advancements in robotic technology hold the potential to optimize this approach for improved patient care.

Comparing robotic and open partial nephrectomy under the prism of surgical precision: a meta-analysis of the average blood loss rate as a novel variable

Exploration of surgical precision in robotic procedures is extensive, yet lacks a unified framework for comparability. This study examines tissue handling precision by comparing the per-minute blood loss rate between robotic and open partial nephrectomy. A literature search from August 2022 to June 2024 identified 43 relevant studies providing data on estimated blood loss and procedure duration. The expected values and standard errors of these variables were used to compute the per-minute blood loss rate (Q). Meta-analytical methods estimated pooled and subgroup-level mean differences, favoring robotic surgery (MDQ = - 1.043 ml/min, CI95% = [- 1.338; - 0.747]). Subgroup analyses by publication year, patient matching, referral center count, and ROBINS-I status consistently supported this advantage. Sensitivity analyses confirmed the above benefit in studies with increased accuracy in reported results (MDQ = - 0.957 ml/min, CI95% = [- 1.269; - 0.646]), low risk of bias involving matched comparisons (MDQ = - 0.563 ml/min, CI95% = [- 0.716; - 0.410]), large sample sizes and increased statistical power (MDQ = - 0.780 ml/min, CI95% = [- 1.134; - 0.425]), and multicenter analyses with patient matching (MDQ = - 0.481 ml/min, CI95% = [- 0.698; - 0.263]). The subsequent analysis of correlation between the original variables suggested a slight reduction in the robotic advantage when the latter were proportionally related. Multilevel meta-regression at both temporal and qualitative scales consistently indicated a comparative benefit of the robotic approach. Potentially, lower per-minute blood loss compared to open surgery suggests that robotic partial nephrectomy demonstrates enhanced precision in tissue handling.

Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database

Introduction

There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN.

Methods

For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers.

Results

In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively.

Conclusions

This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review

Background: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. Methods: A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. Results: Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. Conclusions: RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.