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Li W, Hua B, Song S, Pan W, Yang Q, Xu B. From sutureless to standard: a comprehensive analysis of conversion rates in laparoscopic partial nephrectomy. BMC Urol 2024; 24:183. [PMID: 39198764 PMCID: PMC11351731 DOI: 10.1186/s12894-024-01578-6] [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] [Received: 04/02/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
OBJECTIVE To assess the rate at which sutureless partial nephrectomy (SLPN) transitions to standard partial nephrectomy (SPN), focusing on preoperative factors that might prompt such conversions. PATIENTS AND METHODS In this retrospective study, we analyzed the efficacy of SLPN performed on adults at our institution from 2016 to 2023. The subjects were patients diagnosed with localized solid renal tumors. The primary technique employed was resection with scissors and argon beam coagulation for hemostasis, with suturing techniques used only when necessary. Predictive factors necessitating conversion to SPN were identified, and the associations among multiple variables were explored using various statistical analysis methods, including logistic regression, to identify key preoperative predictive factors. RESULTS Our institution performed 353 SLPN, with 21 cases (5.9%) necessitating conversion to SPN. The conversion rates for the Laparoscopic Partial Nephrectomy (LPN) subgroup and the Robotic-assist Partial Nephrectomy (RPN) subgroup were 7.9% (17/215) and 2.9% (4/138), respectively, nearing statistical significance (P = .066). Significant differences were observed between the conversion group and the no conversion group in terms of preoperative estimated Glomerular Filtration Rate (eGFR), age at surgery, tumor size, and exophytic/endophytic characteristics. Multivariate analysis identified age at surgery, preoperative eGFR, radiological tumor size, and tumor exophytic/endophytic nature as significant predictors for conversion to SPN. CONCLUSION This investigation highlights the efficacy and feasibility of SLPN while identifying critical factors influencing the necessity for conversion to SPN. The identified predictors, including younger surgical age, superior preoperative eGFR, and specific tumor characteristics, provide valuable insights for refining surgical strategies.
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Affiliation(s)
- Wenfeng Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Bao Hua
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Sangqing Song
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Weixin Pan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qing Yang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Xiao Y, Shan ZJ, Yang JF, Len JJ, Yu YH, Yang ML. Nephrometric scoring system: Recent advances and outlooks. Urol Oncol 2023; 41:15-26. [PMID: 35907706 DOI: 10.1016/j.urolonc.2022.06.019] [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: 12/16/2021] [Revised: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
A nephrometry scoring system is a key standard to evaluate the feasibility of partial nephrectomy (PN). Whether based on two-dimensional or three-dimensional images, simplicity, effectiveness, and practicality are the keys to the nephrometric scoring system. Since the emergence of RENAL score in 2009, numerous scoring systems based on different anatomical parameters are established to seek accurately and few parameters to assess the risk of PN and complications. This study aimed to achieve a three-game winning streak in PN more easily and efficiently (negative resection margin, maximum preservation of normal nephron function, and avoiding short-term and long-term complications). Using PubMed, we counted 28 kinds of nephrometric scoring systems. We considered only English literatures published and excluded editorials, commentaries, and meeting abstracts. To the best of our knowledge, this is to date and most comprehensive summary as well as an outlook of the nephrometric scoring system.
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Affiliation(s)
- Yu Xiao
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zu-Juan Shan
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jun-Feng Yang
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jin-Jun Len
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yan-Hong Yu
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
| | - Mao-Lin Yang
- The Affiliated Hospital, Kunming University of Science and Technology, Kunming, China; Department of Urology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
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3
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Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, Ahlawat R, Rawal S, Buffi NM, Sivaraman A, Porter JR, Rogers C, Mottrie A, Abaza R, Rha KH, Moon D, Yuvaraja TB, Parekh DJ, Capitanio U, Maes KK, Porpiglia F, Turkeri L, Gautam G. Development and Validation of a Nomogram Predicting Intraoperative Adverse Events During Robot-assisted Partial Nephrectomy. Eur Urol Focus 2022; 9:345-351. [PMID: 36153228 DOI: 10.1016/j.euf.2022.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/27/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ability to predict the risk of intraoperative adverse events (IOAEs) for patients undergoing partial nephrectomy (PN) can be of great clinical significance. OBJECTIVE To develop and internally validate a preoperative nomogram predicting IOAEs for robot-assisted PN (RAPN). DESIGN, SETTING, AND PARTICIPANTS In this observational study, data for demographic, preoperative, and postoperative variables for patients who underwent RAPN were extracted from the Vattikuti Collective Quality Initiative (VCQI) database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS IOAEs were defined as the occurrence of intraoperative surgical complications, blood transfusion, or conversion to open surgery/radical nephrectomy. Backward stepwise logistic regression analysis was used to identify predictors of IOAEs. The nomogram was validated using bootstrapping, the area under the receiver operating characteristic curve (AUC), and the goodness of fit. Decision curve analysis (DCA) was used to determine the clinical utility of the model. RESULTS AND LIMITATIONS Among the 2114 patients in the study cohort, IOAEs were noted in 158 (7.5%). Multivariable analysis identified five variables as independent predictors of IOAEs: RENAL nephrometry score (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25); clinical tumor size (OR 1.01, 95% CI 1.001-1.024); PN indication as absolute versus elective (OR 3.9, 95% CI 2.6-5.7) and relative versus elective (OR 4.2, 95% CI 2.2-8); Charlson comorbidity index (OR 1.17, 95% CI 1.05-1.30); and multifocal tumors (OR 8.8, 95% CI 5.4-14.1). A nomogram was developed using these five variables. The model was internally valid on bootstrapping and goodness of fit. The AUC estimated was 0.76 (95% CI 0.72-0.80). DCA revealed that the model was clinically useful at threshold probabilities >5%. Limitations include the lack of external validation and selection bias. CONCLUSIONS We developed and internally validated a nomogram predicting IOAEs during RAPN. PATIENT SUMMARY We developed a preoperative model than can predict complications that might occur during robotic surgery for partial removal of a kidney. Tests showed that our model is fairly accurate and it could be useful in identifying patients with kidney cancer for whom this type of surgery is suitable.
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Affiliation(s)
- Gopal Sharma
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Milap Shah
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Prokar Dasgupta
- Faculty of Life Sciences and Medicine, King's Health Partners, King's College, London, UK
| | | | | | | | - Sudhir Rawal
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | | | | | | | | | - Ronney Abaza
- Central Ohio Urology Group and Mount Carmel Health System Prostate Cancer Program, Columbus, OH, USA
| | - Khoon Ho Rha
- Yonsei University Health System, Seoul, South Korea
| | - Daniel Moon
- Peter MacCallum Cancer Centre, Royal Melbourne Clinical School, University of Melbourne, Melbourne, Australia
| | | | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kris K Maes
- Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Lisbon, Portugal
| | | | - Levent Turkeri
- Department of Urology, Acıbadem M.A, Aydınlar University, Altuzinade Hospital, Istanbul, Turkey
| | - Gagan Gautam
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India.
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4
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Goldman B, Rudoff M, Qi J, Wenzler D. Factors Affecting Robotic Partial Nephrectomy Conversion to Radical Nephrectomy: A Retrospective Multi-Institutional Analysis in the Michigan Urologic Surgery Improvement Collaborative (MUSIC). Cureus 2021; 13:e20477. [PMID: 35047296 PMCID: PMC8760021 DOI: 10.7759/cureus.20477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify factors related to the conversion of robot-assisted partial nephrectomy (RPN) to robot-assisted radical nephrectomy (RRN) based on data collected by a statewide database in Michigan. METHODS Using the Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) database we identified 574 patients for whom RPN was planned. Patient and tumor characteristics were obtained including body mass index (BMI), Charlson comorbidity index (CCI), RENAL nephrometry score, tumor size, and pathologic staging. Treating centers were subdivided by annualized case volume and academic status. Bivariate and multivariate analyses were performed to assess the impact of these factors on the risk of conversion to RRN from RPN. RESULTS The conversion rate of RPN to RN was 5.75% (33/574). The difference in RENAL nephrometry score, tumor stage, and size reached statistical significance on bivariate analysis (p<0.001). The tumor stage also reached statistical significance on multivariate analysis [odds ratio (OR); 95%CI (8.97; 3.93-20.48) p<0.001]. The conversion rate was lower among high-volume versus low-volume practices; however, statistical significance was not reached [5.2% (27/520) vs.11% (6/54); p=0.11]. CONCLUSIONS Patient factors such as tumor size and renal nephrometry score are likely related to the conversion of RPN to RRN decisions. The data shows that Michigan urologists appear to appropriately assess intra-operative findings and convert to RRN in cases of more advanced kidney tumors. Lower volume centers appear to trend towards a higher conversion rate. Continued quality improvement tracking analysis may further clarify this relationship.
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Affiliation(s)
| | | | - Ji Qi
- Urology, University of Michigan, Ann Arbor, USA
| | - David Wenzler
- Urology, Ascension Providence Hospital, Southfield, USA
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5
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Yumioka T, Honda M, Teraoka S, Kimura Y, Iwamoto H, Morizane S, Hikita K, Takenaka A. The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy. Yonago Acta Med 2021; 64:184-191. [PMID: 34025193 DOI: 10.33160/yam.2021.05.010] [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: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/05/2022]
Abstract
Background We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series. Methods We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann-Whitney U test were used for statistical analyses of variables. Results Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556). Conclusion Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.
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Affiliation(s)
- Tetsuya Yumioka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Gurung PMS, Melnyk R, Holler T, Oppenhimer D, Witthaus M, Rashid HH, Frye TP, Wu G, Joseph JV, Ghazi AE. Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses. J Endourol 2021; 35:383-389. [PMID: 33451273 DOI: 10.1089/end.2020.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The use of volume-rendered images is gaining popularity in the surgical planning for complex procedures. IRIS™ is an interactive software that delivers three-dimensional (3D) virtual anatomical models. We aimed to evaluate the preoperative clinical utility of IRIS for patients with ≤T2 localized renal tumors who underwent either partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods: Six urologists (four faculty and two trainees) reviewed CT scans of 40 cases over 2 study phases, using conventional two-dimensional (2D) CT alone (Phase-I), followed by the CT + IRIS 3D model (Phase-II). After each review, surgeons reported their decision on performing a PN or an RN and rated (Likert scale) their confidence in completing the procedure as well as how the imaging modality influenced specific procedural decisions. Modifications to the choice of procedure and confidence in decisions between both phases were compared for the same surgeon. Concordance between surgeons was also evaluated. Results: A total of 462 reviews were included in the analysis (231 in each phase). In 64% (95% CI: 58-70%) of reviews, surgeons reported that IRIS achieved a better spatial orientation, understanding of the anatomy, and offered additional information compared with 2D CT alone. IRIS impacted the planned procedure in 20% of the reviews (3.5% changed decision from PN to RN and 16.5% changed from RN to PN). In the remaining 80% of reviews, surgeons' confidence increased from 78% (95% CI: 72-84%) with 2D CT, to 87% (95% CI: 82-92%) with IRIS (p = 0.02); this confidence change was more pronounced in cases with a high RENAL score (p = 0.009). In 99% of the reviews, surgeons rated that the IRIS accurately represented the anatomical details of all kidney components. Conclusion: Application of IRIS 3D models could influence the surgical decision-making process and improve surgeons' confidence, especially for robot-assisted management of complex renal tumors.
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Affiliation(s)
- Pratik M S Gurung
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel Oppenhimer
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael Witthaus
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Hani H Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean V Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed E Ghazi
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Simulation Innovation Laboratory, University of Rochester Medical Center, Rochester, New York, USA
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7
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Yasuda Y, Saito K, Tanaka H, Uehara S, Kijima T, Yoshida S, Yokoyama M, Matsuoka Y, Kihara K, Fujii Y. Outcomes of gasless laparoendoscopic single-port partial nephrectomy in 356 consecutive patients: Feasibility of a clampless and sutureless technique. Int J Urol 2020; 28:302-307. [PMID: 33300187 DOI: 10.1111/iju.14452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate the outcomes and feasibilities of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy. METHODS We reviewed 356 consecutive patients with primary unilateral non-metastatic renal masses who underwent gasless laparoendoscopic single-port partial nephrectomy (2011-2018), which was performed retroperitoneally using a three-dimensional flexible endoscope, without vascular clamping or renorrhaphy in principle. RESULTS The median tumor size was 2.5 cm, and 213 (60%), 105 (29%), and 38 (11%) patients had peripheral, central, and hilar tumors, respectively. Clampless and sutureless partial nephrectomy was accomplished in 337 patients (95%), while eight (2%) and 16 (4%) patients required vascular clamping and renorrhaphy, respectively. The median operative time and blood loss were 220 min and 266 mL, respectively; eight patients (2%) received blood transfusion. Clavien-Dindo grade 3a complications occurred in 27 patients (8%); all these patients had urinary leakage treated with ureteral stent placement, one of whom also developed a postoperative pseudoaneurysm. Among 324 patients diagnosed with renal cell carcinoma, six (2%) had positive surgical margins, and one (0.3%) and seven (2%) developed metastatic and local recurrences, respectively. During a median follow-up of 54 months, no patient died from kidney cancer. The median percent decrease in estimated glomerular filtration rate at 3 months after surgery was 5.7%. No patient experienced postoperative acute renal failure, while one patient with preexisting renal impairment started dialysis at 70 months after surgery. CONCLUSIONS Clampless and sutureless partial nephrectomy can be safely accomplished in most patients undergoing gasless laparoendoscopic single-port surgery, yielding favorable oncological and functional outcomes.
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Affiliation(s)
- Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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8
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Arora S, Bronkema C, Porter JR, Mottrie A, Dasgupta P, Challacombe B, Rha KH, Ahlawat RK, Capitanio U, Yuvaraja TB, Rawal S, Moon DA, Sivaraman A, Maes KK, Porpiglia F, Gautam G, Turkeri L, Bhandari M, Jeong W, Menon M, Rogers CG, Abdollah F. Omission of Cortical Renorrhaphy During Robotic Partial Nephrectomy: A Vattikuti Collective Quality Initiative Database Analysis. Urology 2020; 146:125-132. [DOI: 10.1016/j.urology.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
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9
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Klein G, Wang H, Elshabrawy A, Nashawi M, Gourley E, Liss M, Kaushik D, Wu S, Rodriguez R, Mansour AM. Analyzing National Incidences and Predictors of Open Conversion During Minimally Invasive Partial Nephrectomy for cT1 Renal Masses. J Endourol 2020; 35:30-38. [PMID: 32434388 DOI: 10.1089/end.2020.0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: To analyze predictors of open conversion during minimally invasive partial nephrectomy (MIPN) for cT1 renal masses. Methods: The National Cancer Database (NCDB) was investigated for kidney cancer patients who underwent partial nephrectomy (PN) between 2010 and 2015. Patients who underwent MIPN were stratified into converted and nonconverted groups. Sociodemographics, facility characteristics, and surgical outcomes were compared between the two groups, and multivariate logistic regression model was fitted to identify independent predictors of open conversion. Results: In total, 54,246 patients underwent PN for kidney cancer during the 6-year period. Of those, 18,994 (35%) were open partial nephrectomies (OPNs) and 35,252 (64%) were MIPN. Overall, 1010 (2.87%) of MIPNs were converted to OPN. There was an increasing utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion had more 30-day readmissions (5.95% vs 3.31%, p < 0.01). On multivariate analysis; high-volume facility (>30 MIPNs/year), year of surgery (2015 vs 2010), and robotic approach predicted a lower likelihood of conversion (odds ratio [OR] 0.52, confidence interval [CI] 0.44-0.62; OR 0.59, CI 0.47-0.73; and OR 0.31, CI 0.27-0.35; respectively, p < 0.001 for all). Conversely, Medicaid (vs private insurance; OR 1.75, CI 1.39-2.19, p < 0.001) and male sex (OR 1.26, CI 1.11-1.44, p < 0.001) were independent predictors of conversion. Conclusions: Open conversion in MIPN occurred in 2.87% of cases. There was an increasing utilization of MIPN associated with decreased conversion rates. Higher volume hospitals and progressing year of surgery were associated with less likelihood of conversion.
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Affiliation(s)
- Geraldine Klein
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Hanzhang Wang
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed Elshabrawy
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Mouhamed Nashawi
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Eric Gourley
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Michael Liss
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Dharam Kaushik
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Shenghui Wu
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald Rodriguez
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology and UT Health San Antonio, San Antonio, Texas, USA.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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10
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Porpiglia F, Amparore D, Pecoraro A, Checcucci E. Are nephrometry scores enough to select patients really fit for nephron sparing surgery? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S217. [PMID: 31656796 DOI: 10.21037/atm.2019.08.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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11
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Ficarra V, Rossanese M, Giannarini G, Crestani A, Simonato A, Inferrera A. The use of nephrometry scoring systems can help urologists predict the risk of conversion to radical nephrectomy in patients scheduled for partial nephrectomy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S213. [PMID: 31656792 DOI: 10.21037/atm.2019.08.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Marta Rossanese
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Alessandro Crestani
- Urology Unit, "Santa Maria Regina degli Angeli" Hospital, Adria, Rovigo, Italy
| | - Alchiede Simonato
- Department of Surgical Oncological and Oral Sciences, Urologic Section, University of Palermo, Palermo, Italy
| | - Antonino Inferrera
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
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Garg H, Tiwari D, Nayak B, Singh P, Yadav S, Kumar R, Seth A, Nayyar R, Dogra P. A comparative analysis of various surgical approaches of nephron-sparing surgery and correlation of histopathological grade with RENAL nephrometry score in renal cell carcinoma. J Minim Access Surg 2019; 16:144-151. [PMID: 30777990 PMCID: PMC7176007 DOI: 10.4103/jmas.jmas_208_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Nephron-sparing surgery (NSS) is the standard of care for small renal masses whenever feasible. This study aims to evaluate the perioperative outcomes of NSS performed by open (open partial nephrectomy [OPN]) or laparoscopic (laparoscopic PN [LPN]) or robotic (robotic PN [RPN]) approach over the past 6 years and to study the correlation of histopathological grade of renal cell carcinoma with the RENAL score. Materials and Methods: A retrospective analysis of prospectively collected data of all patients who underwent NSS was done. Results: A total of 135 patients underwent NSS. The mean tumour size was 4.4 cm. About 61 patients underwent OPN, 24 had LPN and 50 had RPN. Although tumour size was larger in OPN group (P = 0.01), tumour complexity based on the RENAL score was similar in OPN and RPN groups (P = 0.15). The OPN group had shorter operative time (P = 0.008) but more blood loss (P = 0.001) and length of hospital stay (P = 0.049) as compared to LPN or RPN group. Maximum radiological diameter of tumour (P = 0.017) appeared to be a significant predictor of operative time, while the open surgical approach (P = 0.003) and tumour stage (P = 0.044) were found to be significant predictors of blood loss. Hilar clamping time was similar in OPN and RPN groups (P = 0.054) but higher in LPN group (P = 0.01). However, post-operative decline in renal function (estimated glomerular filtration rate) (P = 0.08) and margin status were comparable among the three groups. The most common histopathology was clear cell carcinoma (70%), and RENAL score was identified as a significant predictor of histopathological grade of tumour (P = 0.008). Conclusion: Open, laparoscopic and robotic approaches to PN provide similar patient outcomes. OPN was usually preferred for larger tumours. The post-operative decline in renal functions and complications were comparable among the three approaches. RENAL score correlated significantly with histopathological grade and hence could help in predicting tumour behaviour pre-operatively.
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Deviprasad Tiwari
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Yadav
- Department of Urology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Premnath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Abdel Raheem A, Chang KD, Alenzi MJ, Lum TG, Ham WS, Han WK, Chung BH, Choi YD, Rha KH. Robot-Assisted Partial Nephrectomy for Totally Endophytic Renal Tumors: Step by Step Standardized Surgical Technique and Long-Term Outcomes with a Median 59-Month Follow-Up. J Laparoendosc Adv Surg Tech A 2019; 29:1-11. [DOI: 10.1089/lap.2018.0124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Ki Don Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Mohammed Jayed Alenzi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Urology, Aljouf University, Sakaka, Saudi Arabia
| | - Trenton G. Lum
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Arora S, Keeley J, Pucheril D, Menon M, Rogers CG. What is the hospital volume threshold to optimize inpatient complication rate after partial nephrectomy? Urol Oncol 2018; 36:339.e17-339.e23. [DOI: 10.1016/j.urolonc.2018.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/14/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
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Affiliation(s)
- Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan
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