1
|
Pandolfo SD, Wu Z, Campi R, Bertolo R, Amparore D, Mari A, Verze P, Manfredi C, Franco A, Ditonno F, Cerrato C, Ferro M, Lasorsa F, Contieri R, Napolitano L, Tufano A, Lucarelli G, Cilio S, Perdonà S, Siracusano S, Autorino R, Aveta A. Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review. Cancers (Basel) 2024; 16:693. [PMID: 38398084 PMCID: PMC10886610 DOI: 10.3390/cancers16040693] [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: 12/25/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy;
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;
| | - Riccardo Campi
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Riccardo Bertolo
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, 10043 Turin, Italy;
| | - Andrea Mari
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Clara Cerrato
- Urology Unit, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK;
| | - Matteo Ferro
- Division of Urology, IRCCS—European Institute of Oncology, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy;
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| |
Collapse
|
2
|
Msezane LP, Katz MH, Gofrit ON, Shalhav AL, Zorn KC. Hemostatic Agents and Instruments in Laparoscopic Renal Surgery. J Endourol 2008; 22:403-8. [DOI: 10.1089/end.2007.9844] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Lambda P. Msezane
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois
| | - Mark H. Katz
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois
| | - Ofer N. Gofrit
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois
| | - Arieh L. Shalhav
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois
| | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois
| |
Collapse
|
3
|
Zhang X, Li HZ, Ma X, Zheng T, Li LC, Ye ZQ. Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors: Report of 32 cases. Urology 2005; 65:1080-4; discussion 1084-5. [PMID: 15913730 DOI: 10.1016/j.urology.2004.12.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 11/13/2004] [Accepted: 12/03/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephron-sparing surgery for renal tumors. METHODS Between June 2002 and February 2004, 11 cases of renal benign tumor and 21 cases of renal malignant tumor underwent enucleation of the tumor and wedge resection of the tumor through retroperitoneal laparoscopy, respectively. Tumor resection and hemostasis were mainly achieved by harmonic scalpel. Follow-up studies were performed with an evaluation using renal spiral computed tomography. RESULTS All procedures were technically successful. The mean operating time was 70 minutes for enucleation and 96 minutes for wedge resection. The mean estimated blood loss was 35 mL for enucleation and 65.5 mL for wedge resection. The mean hospital stay after surgery was 6.5 days. No intraoperative complications occurred. The pathologic examination confirmed renal cell carcinoma in 21 patients and angiomyolipoma in 11. The pathologic stage was pT1a in the 21 patients with renal cell carcinoma. All resected tumor specimens had negative surgical margins for cancer. No local recurrence or trocar site metastasis was observed during a mean follow-up period of 13 months. CONCLUSIONS Our results indicate that retroperitoneal laparoscopic nephron-sparing surgery represents a feasible option for patients with localized renal tumors. This procedure could offer precise and complete tumor excision while minimizing morbidity, improving cosmesis, and shortening convalescence.
Collapse
Affiliation(s)
- Xu Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | | | | | | | | | | |
Collapse
|
4
|
Bove P, Bhayani SB, Rha KH, Allaf ME, Jarrett TW, Kavoussi LR. NECESSITY OF URETERAL CATHETER DURING LAPAROSCOPIC PARTIAL NEPHRECTOMY. J Urol 2004; 172:458-60. [PMID: 15247702 DOI: 10.1097/01.ju.0000130332.35800.08] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Laparoscopic partial nephrectomy (LPN) is a relatively recently introduced method of treating renal tumors and, as such, surgical technique is evolving. In open series urinary fistula formation represents a common postoperative complication. In the laparoscopic approach investigators have advocated the placement of a ureteral catheter with retrograde dye injection to visualize caliceal entry to aid in closure. In this study we assessed the necessity of ureteral catheter placement during LPN in decreasing urinary leakage. MATERIALS AND METHODS From February 1998 until November 2002 laparoscopic partial nephrectomy was performed in 103 patients with renal tumors. The patients were assessed retrospectively and divided into 2 groups according to placement (group 1) or no placement (group 2) of an external ureteral catheter. Group 1 included 54 patients (mean age +/- SD 57.4 +/- 13.4 years) and group 2 included 49 patients (mean age +/- SD 57.5 +/- 10.9). Intraoperative and postoperative parameters including blood loss, operative time, ischemia time, mass size, complications and hospital stay were reviewed and compared between the 2 groups. RESULTS There were no differences between the 2 groups in mean estimated blood loss (group 1, 394.7 cc vs group 2, 291.5 cc, p = 0.07), postoperative serum creatinine (group 1, 0.95 mg/dl vs group 2, 0.89 mg/dl, p = 0.12), requirement for pain medication (group 1, 8.9 mg vs group 2, 4.9 mg morphine equivalents, p = 0.12), hospital stay (group 1, 3.1 vs group 2, 2.9, p = 0.29) and warm ischemia time (group 1, 28 minutes vs group 2, 26.5 minutes, p = 0.18). Mean total operative time was significantly longer for group 1 compared to group 2 (191.1 vs 149.4 minutes, respectively, p = 0.001). Postoperative urinary leakage requiring prolonged drainage occurred in 1 patient in group 1 and 1 in group 2. In both cases caliceal entry was identified and sutured. CONCLUSIONS With experience caliceal entry can be identified without the need for a ureteral catheter in patients undergoing LPN for a tumor less than 4.5 cm. Urinary fistula may occur despite caliceal entry and repair. A ureteral catheter may not decrease urinary fistula in patients undergoing LPN.
Collapse
Affiliation(s)
- Pierluigi Bove
- Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
| | | | | | | | | | | |
Collapse
|
5
|
Abstract
This article describes the principles, attributes, and pitfalls of the many MR imaging approaches available for assessment of renal-related disorders. Tables 1 and 2 summarize the specific approach and rationale.
Collapse
Affiliation(s)
- Jingbo Zhang
- Department of Radiology, Beth Israel Deaconess Medical Center, Shapiro 4 Clinical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | | | | |
Collapse
|
6
|
Bermudez H, Guillonneau B, Gupta R, Adorno Rosa J, Cathelineau X, Fromont G, Vallancien G. Initial experience in laparoscopic partial nephrectomy for renal tumor with clamping of renal vessels. J Endourol 2003; 17:373-8. [PMID: 12965062 DOI: 10.1089/089277903767923146] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe our initial experience with laparoscopic partial nephrectomy (LPN) with clamping of the renal vessels before tumor excision and suturing of the renal parenchyma. PATIENTS AND METHODS Between July 2001 and April 2002, 19 consecutive patients underwent transperitoneal LPN in our institution, 14 for tumors <4 cm with suspicion of renal-cell cancer and 5 for suspicion of angiomyolipoma at CT with one tumor confirmed histopathologically by percutaneous needle biopsy. We divided these patients into the first 10 cases (Group 1) and the last 9 cases (Group 2). One patient had end-stage renal disease but was not on dialysis; the remaining patients had elective partial nephrectomy. Initially, a ureteral catheter was placed. The partial nephrectomy was performed with clamping of the renal vessels, so that the tumor was excised with cold scissors. Intracorporeal cooling of the kidney was achieved by a ureteral catheter connected to a 4 degrees C solution flowing to the renal pelvis during the whole procedure until the clamps were released. Intracorporeal free-hand suturing was exclusively used to close the collecting system (when opened) and to approximate the renal parenchyma. RESULTS All procedures were completed laparoscopically. The mean renal warm ischemia time was 28.5+/-7 minutes (range 15-47 minutes). The mean laparoscopic operating time was 125+/-37 minutes (range 90-390 minutes). The mean intraoperative blood loss was 290+/-276 mL (range 25-1200 mL). Two patients required blood transfusion, and four had complications. There was immediate deterioration in renal function (creatinine 1.42+/-0.56 mg/dL), but improvement was seen at 1 month (1.17+/-0.34 mg/dL). There were no statistically significant differences in operative features and outcomes in Groups 1 and 2, but there were improvements in the mean operating time by 30 minutes, the mean intraoperative blood loss by 113 mL without any transfusion, and the mean renal warm ischemia time by 6 minutes. There was only one patient in Group 2 with a complication. The surgical margin was negative for tumor for all patients. Postoperative pathology examination showed renal-cell cancer in 11 patients (pT1), oncocytoma in 3 patients, and angiomyolipoma in 5 patients. The mean tumor grade was 2. The mean tumor size was 25.8+/-11.6 mm with a mean tumor-free margin of 2.6+/-2.4 mm. The median follow-up is 3 months, so oncologic outcome cannot be assessed. CONCLUSION The technique of LPN can be standardized and should be proposed for small tumors when they are not invading the hilum. Clamping the renal pedicle allows better vision for more accurate tumor excision with a safety margin and hemostatic suturing of the parenchymal defect, resulting in less blood loss and shorter operative time, parameters that improve with experience.
Collapse
Affiliation(s)
- Hugo Bermudez
- Department of Urology, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | | | |
Collapse
|
7
|
GUILLONNEAU B, BERMÚDEZ H, GHOLAMI S, EL FETTOUH H, GUPTA R, ADORNO ROSA J, BAUMERT H, CATHELINEAU X, FROMONT G, VALLANCIEN G. Laparoscopic Partial Nephrectomy for Reanl Tumor: Single Center Experience Comparing Clamping and No Clamping Techniques of the Renal Vasculature. J Urol 2003. [DOI: 10.1016/s0022-5347(05)63939-0] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B. GUILLONNEAU
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - H. BERMÚDEZ
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - S. GHOLAMI
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - H. EL FETTOUH
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - R. GUPTA
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - J. ADORNO ROSA
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - H. BAUMERT
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - X. CATHELINEAU
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - G. FROMONT
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| | - G. VALLANCIEN
- From the Departments of Urology and Pathology, Institut Mutualiste Montsouris, Paris, France
| |
Collapse
|
8
|
Paterson RF, Barret E, Siqueira TM, Gardner TA, Tavakkoli J, Rao VV, Sanghvi NT, Cheng L, Shalhav AL. Laparoscopic partial kidney ablation with high intensity focused ultrasound. J Urol 2003; 169:347-51. [PMID: 12478187 DOI: 10.1016/s0022-5347(05)64124-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE High intensity focused ultrasound has been performed for transrectal and extracorporeal thermal ablation of tissues. We developed and tested a laparoscopic probe that allows real-time ultrasound imaging during partial renal ablation using high intensity focused ultrasound. METHODS A Sonablate 200 (Focus Surgery, Indianapolis, Indiana) high intensity focused ultrasound system with a modified 18 mm. laparoscopic probe was used in all experiments. In 13 Yucatan mini-pigs a 5Fr ureteral catheter was inserted into the renal pelvis and 10 cc air were instilled into the collecting system. The kidney was laparoscopically dissected, the high intensity focused ultrasound probe was inserted through a 33 mm. laparoscopic port and the targeted renal pole was treated. RESULTS Renal lesions were created in 12 of 13 treated kidneys under real-time ultrasound visualization. Median operative time was 180 minutes, average high intensity focused ultrasound activation time was 18.3 minutes and lesion size was 23 x 17 x 11 mm. At 4 and 14 days 4 (acute group) and 6 (subacute group) animals were available for renal functional and anatomical evaluation, respectively. No difference in renal function was seen in treated and untreated kidneys. Pathological examination at 14 days revealed homogenous and complete tissue necrosis throughout the whole volume of the lesion with sharp demarcation from adjacent normal tissue. CONCLUSIONS We were able to refine a probe for laparoscopic high intensity focused ultrasound delivery capable of simultaneous ultrasound imaging. Partial renal ablation using this probe is feasible and safe, and resulted in homogenous, complete and reproducible lesions.
Collapse
Affiliation(s)
- Ryan F Paterson
- Department of Urology, Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, Indiaiapolis, IN, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Literature watch. J Laparoendosc Adv Surg Tech A 2002; 12:85-7. [PMID: 11905869 DOI: 10.1089/109264202753487019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Schulam PG, Dekernion JB. Editorial Comment: Laparoscopic Nephrectomy for Renal-Cell Carcinoma: The Current Situation. J Endourol 2001. [DOI: 10.1089/089277901300189376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
12
|
Abstract
Since the first reported case of laparoscopic nephrectomy by Clayman et al. in 1991, laparoscopy is gaining acceptance as a viable alternative to open surgery for renal cell carcinoma. The benefits of laparoscopy include improved quality of life and lower incidence of perioperative morbidity. The perceived risks of laparoscopic nephrectomy for renal cell carcinoma include port-site metastasis, increased operative time, and the concern for inadequate surgical resection. The preliminary data concerning laparoscopy in renal cell carcinoma, however, indicate that rates of tumor recurrence are equivalent to open surgery while resulting in better cosmesis, decreased level of perioperative analgesic use, and decreased length of time to full convalescence.
Collapse
Affiliation(s)
- I Y Kim
- Scott Department of Urology, Baylor College of Medicine, 6560 Fannin, Suite 2100, Houston, TX 77030, USA
| | | |
Collapse
|