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Mihai I, Dura H, Teodoru CA, Todor SB, Ichim C, Grigore N, Mohor CI, Mihetiu A, Oprinca G, Bacalbasa N, Tanasescu D, Bratu DG, Boicean A, Oros B, Hasegan A. Intraoperative Ultrasound: Bridging the Gap between Laparoscopy and Surgical Precision during 3D Laparoscopic Partial Nephrectomies. Diagnostics (Basel) 2024; 14:942. [PMID: 38732356 PMCID: PMC11083918 DOI: 10.3390/diagnostics14090942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.
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Affiliation(s)
- Ionela Mihai
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Horatiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cosmin Adrian Teodoru
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Nicolae Grigore
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Alin Mihetiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - George Oprinca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Nicolae Bacalbasa
- Surgery Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Denisa Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Bogdan Oros
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
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Ali S, Ahn T, Papa N, Perera M, Teloken P, Coughlin G, Wood ST, Roberts MJ. Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data. ANZ J Surg 2019; 90:48-52. [PMID: 31478323 DOI: 10.1111/ans.15385] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
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Affiliation(s)
- Stephen Ali
- Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Teloken
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Geoffrey Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia
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