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Campi R, Sessa F, Rivetti A, Pecoraro A, Barzaghi P, Morselli S, Polverino P, Nicoletti R, Li Marzi V, Spatafora P, Sebastianelli A, Gacci M, Vignolini G, Serni S. Case Report: Optimizing Pre- and Intraoperative Planning With Hyperaccuracy Three-Dimensional Virtual Models for a Challenging Case of Robotic Partial Nephrectomy for Two Complex Renal Masses in a Horseshoe Kidney. Front Surg 2021; 8:665328. [PMID: 34136528 PMCID: PMC8200488 DOI: 10.3389/fsurg.2021.665328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
Objective: To report a case of robot-assisted partial nephrectomy (RAPN) for two highly complex renal tumors in a patient with a Horseshoe kidney (HSK), focusing on the utility of hyperaccuracy three-dimensional (HA3D) virtual models for accurate preoperative and intraoperative planning of the procedure. Methods: A 74-year-old Caucasian male patient was referred to our Unit for incidental detection of two complex renal masses in the left portion of a HSK. The 50 × 55 mm, larger, predominantly exophytic renal mass was located at the middle-lower pole of the left-sided kidney (PADUA score 9). The 16 × 17 mm, smaller, hilar renal mass was located at the middle-higher pole of the left-sided kidney (PADUA score 9). Contrast-enhanced CT scan images in DICOM format were processed using a dedicated software to achieve a HA3D virtual reconstructions. RAPN was performed by a highly experienced surgeon using the da Vinci Si robotic platform with a three-arm configuration. A selective delayed clamping strategy was adopted for resection of the larger renal mass while a clampless strategy was adopted for the smaller renal mass. An enucleative resection strategy was pursued for both tumors. Results: The overall operative time was 150 min, with a warm ischemia time of 21 min. No intraoperative or postoperative complications were recorded. Final resection technique according to the SIB score was pure enucleation for both masses. At histopathological analysis, both renal masses were clear cell renal cell carcinoma (ccRCC) (stage pT1bNxMx and pT3aNxMx for the larger and smaller mass, respectively). At a follow-up of 7 months, there was no evidence of local or systemic recurrence. Conclusions: Surgical management of complex renal masses in patients with HSKs is challenging and decision-making is highly nuanced. To optimize postoperative outcomes, proper surgical experience and careful preoperative planning are key. In this regard, 3D models can play a crucial role to refine patient counseling, surgical decision-making, and pre- and intraoperative planning during RAPN, tailoring surgical strategies and techniques according to the single patient's anatomy.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Morselli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Rossella Nicoletti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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2
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Papalia R, Panebianco V, Mastroianni R, Del Monte M, Altobelli E, Faiella E, Grasso FR, Bellangino M, Simone G, Ciccozzi M, Angeletti S, D'ovidio G, Catalano C, Gallucci M, Scarpa RM, Muto G. Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors. World J Urol 2019; 38:407-415. [PMID: 31025082 DOI: 10.1007/s00345-019-02755-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. METHODS From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). RESULTS A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI-Cap 0: 0.89 (p < 0.0001), MRI-Cap1: 0.75 (p < 0.0001), MRI-Cap 2: 0.76 (p < 0.0001), and MRI-Cap3: 0.87 (p < 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were: MRI-Cap 0: Se 97.87% Spec 83.3%, PPV 95.8%, NPV 90.9%, and AUC 90.9; MRI-Cap 1: Se 77% Spec 95.5%, PPV 83.3%, NPV 93.5%, and AUC 0.86; MRI-Cap 2- iCap 2: Se 88% Spec 90%, PPV 79%, NPV 95%, and AUC 0.89; MRI-Cap 3: Se 94% Spec 95%, PPV 88%, NPV 97%, and AUC 0.94. CONCLUSIONS MRI-Cap classification is accurate in evaluating renal tumor PC features. PC features can provide an imaging-guided landmark to figure out where a minimal margin could be preferable during nephron-sparing surgery.
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Affiliation(s)
- Rocco Papalia
- Department of Urology, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Valeria Panebianco
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuela Altobelli
- Department of Urology, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Eliodoro Faiella
- Department of Diagnostic and Interventional Radiology, Campus Bio-medico University of Rome, Rome, Italy
| | - Francesco Rosario Grasso
- Department of Diagnostic and Interventional Radiology, Campus Bio-medico University of Rome, Rome, Italy
| | - Mariangela Bellangino
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, Campus Bio-medico University of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia D'ovidio
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Mario Scarpa
- Department of Urology, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas "Gardenigo" University, Turin, Italy
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3
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Vartolomei MD, Matei DV, Renne G, Tringali VM, Crișan N, Musi G, Mistretta FA, Russo A, Conti A, Cozzi G, Luzzago S, Catellani M, Cioffi A, Cordima G, Bianchi R, Di Trapani E, Serino A, Delor M, Bianco R, Bottero D, Ferro M, De Cobelli O. Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients. MINERVA UROL NEFROL 2019; 71:31-37. [DOI: 10.23736/s0393-2249.18.03006-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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4
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Bertolo R, Campi R, Klatte T, Kriegmair MC, Mir MC, Ouzaid I, Salagierski M, Bhayani S, Gill I, Kaouk J, Capitanio U. Suture techniques during laparoscopic and robot-assisted partial nephrectomy: a systematic review and quantitative synthesis of peri-operative outcomes. BJU Int 2018; 123:923-946. [PMID: 30216617 DOI: 10.1111/bju.14537] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN). MATERIALS AND METHODS A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot-assisted partial nephrectomy and comparative studies focused on peri-operative outcomes were included in qualitative and quantitative analyses, respectively. RESULTS Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot-assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non-barbed suture. The single-layer suture technique was associated with shorter operating and ischaemia time than the double-layer technique. No comparisons were possible concerning renal functional outcomes because of non-homogeneous data reporting. CONCLUSIONS Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double-layer suture.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | | | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | - Maciej Salagierski
- Urology Department, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Sam Bhayani
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Inderbir Gill
- Keck School of Medicine, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Umberto Capitanio
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA.,Keck School of Medicine, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
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5
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Carini M, Campi R, Mari A, Minervini A. Oncologic Safety of Robotic Partial Nephrectomy: Setting Tiles in the Mosaic of Evidence While Designing Future Research Projects. Eur Urol Focus 2017; 5:357-360. [PMID: 29174613 DOI: 10.1016/j.euf.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/12/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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6
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Antonelli A, Mari A, Longo N, Novara G, Porpiglia F, Schiavina R, Ficarra V, Carini M, Minervini A. Role of Clinical and Surgical Factors for the Prediction of Immediate, Early and Late Functional Results, and its Relationship with Cardiovascular Outcome after Partial Nephrectomy: Results from the Prospective Multicenter RECORd 1 Project. J Urol 2017; 199:927-932. [PMID: 29154848 DOI: 10.1016/j.juro.2017.11.065] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE We sought to determine the predictors of short-term and long-term renal function impairment after partial nephrectomy. MATERIALS AND METHODS Clinical data on 769 consecutive patients who underwent partial nephrectomy were prospectively recorded at a total of 19 urological Italian centers from 2009 to 2012 in the RECORd 1 (Italian Registry of Conservative Renal Surgery) Project. We extracted clinical data on 708 of these patients who were alive, free of recurrent disease and with a minimum 2-year functional followup. RESULTS Of the patients 47.3% underwent open, 36.6% underwent laparoscopic and 16.1% underwent robot-assisted partial nephrectomy. The median baseline estimated glomerular filtration rate was 84.5 ml/minute/1.73 m2 (IQR 69.9-99.1). Immediate (day 3 postoperatively), early (month 1) and late (month 24) renal function impairment greater than 25% from baseline was identified in 25.3%, 21.6% and 14.8% of cases, respectively. Female gender and the baseline estimated glomerular filtration rate were independent predictors of immediate, early and late renal function impairment. Age at diagnosis was an independent predictor of immediate and late impairment. Uncontrolled diabetes was an independent predictor of late impairment only. Open and laparoscopic approaches, and pedicle clamping were independent predictors of immediate and early renal function impairment. Overall 58 of 529 patients (11%) experienced postoperative cardiovascular events. Body mass index and late renal function impairment were independent predictors of those events. CONCLUSIONS Surgically modifiable factors were significantly associated with worse immediate and early functional outcomes after partial nephrectomy while clinically unmodifiable factors affected renal function during the entire followup. Late renal function impairment is an independent predictor of postoperative cardiovascular events.
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Affiliation(s)
- Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Nicola Longo
- Department of Urology, Federico II Hospital, University of Naples, Naples, Italy
| | - Giacomo Novara
- Department of Urology, University of Padua, Padua, Italy
| | - Francesco Porpiglia
- Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Riccardo Schiavina
- Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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7
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Vartolomei MD, Matei DV, Renne G, Tringali VM, Crisan N, Musi G, Mistretta FA, Russo A, Cozzi G, Cordima G, Luzzago S, Cioffi A, Di Trapani E, Catellani M, Delor M, Bottero D, Imbimbo C, Mirone V, Ferro M, de Cobelli O. Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center. Eur Urol Focus 2017; 5:636-641. [PMID: 29111154 DOI: 10.1016/j.euf.2017.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. OBJECTIVE The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. DESIGN, SETTING, AND PARTICIPANTS Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. RESULTS AND LIMITATIONS From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. CONCLUSIONS Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors. PATIENT SUMMARY Robot-assisted partial nephrectomy seems to be the most promising minimally invasive approach in the treatment of renal masses suitable for organ-sparing surgery as midterm (5 yr) oncological outcomes are excellent.
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Affiliation(s)
- Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Deliu Victor Matei
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Giuseppe Renne
- Department of Laboratory and Pathology, European Institute of Oncology, Milan, Italy
| | | | - Nicolae Crisan
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | - Andrea Russo
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giovani Cordima
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Stefano Luzzago
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Antonio Cioffi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | | | | | - Maurizio Delor
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Danilo Bottero
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Ciro Imbimbo
- Division of Urology, University of Naples Federico II, Italy
| | - Vincenzo Mirone
- Division of Urology, University of Naples Federico II, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy.
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy
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8
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Antonelli A, Furlan M, Sodano M, Carobbio F, Tardanico R, Fisogni S, Simeone C. External histopathological validation of the surface-intermediate-base margin score. Urol Oncol 2017; 35:215-220. [DOI: 10.1016/j.urolonc.2016.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022]
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