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Lu X, Guo Z, Yang G, Yang F, Sun Y, Zhang S, Huang J, He M, Wu J, Cheng J, Guo J, Wang H. A novel mini-retractor for retroperitoneal laparoscopic partial nephrectomy. J Surg Oncol 2024; 129:1407-1412. [PMID: 38606525 DOI: 10.1002/jso.27642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 02/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Retroperitoneal partial nephrectomy (RLPN) is the premier treatment for localized renal tumors despite narrow operation space. Many efforts have been taken to facilitate the operation of RLPN, but the optimal resolution remains debatable. OBJECTIVE To explore the feasibility of using Mini-lap to improve workspace and surgical vision in RLPN. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective review of 51 patients who underwent RLPN with Mini-lap from January 2018 to December 2020 was conducted. SURGICAL PROCEDURE Standard RLPN under three poles was performed in all cases. We highlighted the usage of Mini-lap (Teleflex Minilap percutaneous Surgical System) as a novel retractor in RLPN. OUTCOME AND MEASUREMENTS AND STATICAL ANALYSIS Demographics, preoperative, intraoperative, and postoperative outcomes were assessed. RESULTS AND LIMITATIONS All 51 cases completed RLPN with three ports successfully and no conversion to open surgery. The mean diameter of tumors was (3.53 ± 1.05) cm, in which 62.7% (32/51) were located anteriorly. The operation time and warm ischemic time (WIT) were (86.7 ± 15.9) min and (25.6 ± 5) min respectively. Minor complications (Clavien grade 1-2) occurred in 6 cases. The limitations were small sample size, retrospective design, and absence of control. CONCLUSIONS Mini-lap could be used as a mini-retractor in RLPN, sparing extra assistant ports, expanding workspace, and optimizing vision. PATIENT SUMMARY With highlights of larger workspace and less instrument interference, mini-lap could be applied in retroperitoneal laparoscopic partial nephrectomy.
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Affiliation(s)
- Xuwei Lu
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Zhuifeng Guo
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Guanwen Yang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Fan Yang
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Yang Sun
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Sihong Zhang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Jiaqi Huang
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Minke He
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Jiawen Wu
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Jie Cheng
- Department of Urology, Xuhui Hospital, FUDAN University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
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Nguyen TT, Ngo XT, Duong NX, Dobbs RW, Vuong HG, Nguyen DD, Basilius J, Onder NK, Mendiola DF, Hoang TD, Pham DNM, Nguyen A, Thi TMT, Naushad AS, Shahait M, Lee DI. Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis. J Endourol 2024; 38:253-261. [PMID: 38185840 DOI: 10.1089/end.2023.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background: Several centers have reported their experience with single-port robot-assisted partial nephrectomy (SP-RAPN); however, it is uncertain if utilization of this platform represents an improvement in outcomes compared to multiport robot-assisted partial nephrectomy (MP-RAPN). To evaluate this, we performed a meta-analysis to compare the perioperative, oncological, and functional outcomes between SP-RAPN and MP-RAPN. Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 1, 2023. A meta-analysis has been reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and assessing the methodological quality of systematic reviews (AMSTAR) guidelines. The odds ratio (OR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: Of the 374 retrieved abstracts, 29 underwent full-text review, and 8 studies were included in the final analysis, comprising a total cohort of 1007 cases of RAPN (453 SP-RAPN cases and 554 MP-RAPN cases). Compared to MP-RAPN, the SP-RAPN group had a significantly longer ischemia time (MD = 4.6 minutes, 95% CI 2.8 to 6.3, p < 0.001), less estimated blood loss (MD = -12.4 mL, 95% CI -24.6 to -0.3, p = 0.045), higher blood transfusion rate (OR = 2.97, 95% CI 1.33 to 6.65, p = 0.008), and higher postoperative estimated glomerular filtration rate (eGFR) at 6 months (MD = 4.9 mL/min, 95% CI 0.2 to 9.7, p = 0.04). There was no significant difference in other outcomes between the two approaches, including the intraoperative complication, overall postoperative complication, minor postoperative complication (Clavien-Dindo I - II), major postoperative complication (Clavien-Dindo III-V), conversion to radical nephrectomy, pain score on day #1, pain score on discharge, morphine milligram equivalent usage, hospital stay, positive surgical margins, and postoperative eGFR. Conclusions: SP-RAPN represents an emerging technique using a novel platform. Initial studies have demonstrated that SP-RAPN is a safe and feasible approach to performing partial nephrectomy, although with inferior outcomes for ischemia time and blood transfusion rates. Further studies will be necessary to define the best usage of SP-RAPN within the surgeon's armamentarium.
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Affiliation(s)
- Tuan Thanh Nguyen
- Department of Urology, University of California Irvine, Orange, California, USA
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Xuan Thai Ngo
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Ryan W Dobbs
- Cook County Health & Hospitals System, Chicago, Illinois, USA
| | - Huy Gia Vuong
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Basilius
- Department of Urology, University of California Irvine, Orange, California, USA
| | | | | | - Tien-Dat Hoang
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - An Nguyen
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tuyet Mai Tran Thi
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ali Sohrab Naushad
- Department of Urology, University of California Irvine, Orange, California, USA
| | - Mohammed Shahait
- Surgery Department, Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - David I Lee
- Department of Urology, University of California Irvine, Orange, California, USA
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Pérez-Bertólez S, Martín-Solé O, García-Aparicio L. Comparison between mini-laparoscopy, conventional laparoscopy and open approach for ureteropelvic junction obstruction treatment in children. Scand J Urol 2021; 55:307-312. [PMID: 34227907 DOI: 10.1080/21681805.2021.1948098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of the study was to compare 3 mm mini-laparoscopy (mini LP), standard 5 mm laparoscopy (LP) and open surgery for pediatric pyeloplasty in a single center. METHODS Patients who underwent pyeloplasty from 1997 to 2017 at Hospital Sant Joan de Déu were prospectively collected. Demographic data, clinical, surgical and radiological variables were assessed. A multivariate logistic regression analysis was performed in order to identify risks for surgical complications, urinary leak and need for redo-surgery. RESULTS 340 pyeloplasties were performed in this period: 197 open, 30 LP and 113 mini LP. Independent risk factors for surgical complications in a multivariate logistic regression model were: LP (vs mini LP, OR = 3.95; 95% CI: 1.13-13.8), higher differential renal function (each point more increases the risk 6%; 95% CI: 1-11%), older children (every year increases the risk 1.11 times; 95% CI: 1.002-1.225). Open surgery, pelvis diameter or the use of different stents were not risk factors. This model had an 80% PPV and a 92% NPV. LP (OR = 4.65; 95% CI: 1.08-19.96) and longer surgical time (OR = 1.014; 95% CI: 1.003-1.025) were independent risk factors for urinary leak. Higher pelvis diameter (OR = 0.93; 95% CI: 0.87-0.99) and the use of external stents were independent protective risk factors for urinary leak (OR = 0.09; 95% CI: 0.01-0.72). We have not found independent risk factors for redo-surgery in a multivariate logistic regression model. CONCLUSION mini LP can be safely and effectively used to perform pyeloplasty in pediatric patients of all ages.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Luis García-Aparicio
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Pérez-Lanzac A, Romero EJ, Alvarez-Ossorio JL. Postoperative pain and cosmetic results of minilaparoscopic nephrectomy compared to the conventional technique. Actas Urol Esp 2019; 43:124-130. [PMID: 30470586 DOI: 10.1016/j.acuro.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In recent years urology has been focussing on less invasive forms of laparoscopy with less impact on the abdominal wall. The minilaparoscopy (ML) is promising in this regard. Our objective is to compare the results of a series of patients who underwent minilaparoscopic nephrectomy with another series who underwent conventional laparoscopy (CL). MATERIAL AND METHODS We chose 8 nephrectomies performed by mini-laparoscopy in a single hospital (NmL group) from a total of 110 patients included in multiple centres and compared them retrospectively with a contemporary series of 16 patients who underwent CL (NL group). From 1 to 3 3mm and 5mm trocars were used for the NmL and the NL, respectively, one 10mm trocar in the pararectal edge of a Pfannenstiel incision and another 11mm paraumbilical trocar for the optics. Age, BMI, ASA, complications, analgesic requirements in the postoperative period and cosmetic satisfaction were recorded using the Patient Scar Assessment Questionnaire (PSAQ), one month after the intervention. RESULTS Both groups were comparable and there were no differences in terms of surgery time, number of ports used, hospital stay or intra-and postoperative complications. In only one patient from the NmL group, a 3mm trocar had to be replaced by a 5mm trocar and one patient in the NL group was converted to hand-assisted surgery due to severe adherences. The patients in the NmL group had less postoperative pain on the VAS (±0 vs. 4±25, P=.05) and were more satisfied with their appearance on the PSAQ (8.5±1.4 vs. 16.6±3.1, P=.05) compared to the NL group. CONCLUSIONS The results obtained with the ML instrument were similar to those obtained by CL, but with the advantages of less postoperative pain and better cosmetic results.
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Affiliation(s)
| | - E J Romero
- Hospital Ruber Internacional, Madrid, España; Hospital Universitario Puerta del Mar, Cádiz, España
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