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Robot-assisted partial nephrectomy for renal cell carcinoma in the isthmus of horseshoe kidney. Urol Case Rep 2022; 43:102076. [PMID: 35400118 PMCID: PMC8991097 DOI: 10.1016/j.eucr.2022.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
The anatomic features of a horseshoe kidney are unique—the kidney is fixed and poorly mobile, with many arterial and venous blood supplies, thereby complicating minimally invasive surgery for renal cancer in this setting. Several reports have described robot-assisted partial nephrectomy (RAPN) to treat renal cancer in a horseshoe kidney, but no reports of RAPN for renal cancer in the isthmus of a horseshoe kidney have been published to date. This case report describes the technique and usefulness of RAPN for treatment of renal cancer located in the isthmus of a horseshoe kidney. Robot-assisted partial nephrectomy for a horseshoe kidney is technically difficult. The problem is poor kidney mobility and complex blood vessels. This describes the technique and the benefit of RAPN for a tumor in the isthmus. The key is to create an appropriate and safe surgical view for each scene.
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Crockett MG, Giona S, Whiting D, Whitehurst L, Agag A, Malki M, Hussain M, Barber NJ. Nephrometry scores: a validation of three systems for peri-operative outcomes in retroperitoneal robot-assisted partial nephrectomy. BJU Int 2021; 128:36-45. [PMID: 33001563 DOI: 10.1111/bju.15262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To externally validate the RENAL, PADUA and SPARE nephrometry scoring systems for use in retroperitoneal robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS Nephrometry scores were calculated for 322 consecutive patients receiving retroperitoneal RAPN at a tertiary referral centre from 2017. Patients with multiple tumours were excluded. Scores were correlated with peri-operative outcomes, including the trifecta (warm ischaemia time <25 min, no peri-operative complications and a negative surgical margin), both as continuous and categorical variables. Comparisons were performed using Spearman correlation and ability to predict the trifecta was assessed using binomial logistical regression. RESULTS All three scoring systems correlated significantly with the main variables (operating time, warm ischaemia time and estimated blood loss), both as continuous and categorical variables. Only PADUA and SPARE were able to predict achievement of the trifecta (PADUA area under the curve [AUC] 0.623, 95% confidence interval [CI] 0.559-0.668; SPARE AUC 0.612, 95% CI 0.548-0.677). CONCLUSION This study validates the RENAL, PADUA and SPARE scoring systems to predict key intra-operative outcomes in retroperitoneal RAPN. Only PADUA and SPARE were able to predict achievement of the trifecta. As a simplified version of the PADUA scoring system with comparable outcomes, we recommend using the SPARE system.
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Affiliation(s)
- Matthew G Crockett
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Simone Giona
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Danielle Whiting
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Lily Whitehurst
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Ayman Agag
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Manar Malki
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Muddassar Hussain
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Neil J Barber
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
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Choi CI, Kang M, Sung HH, Jeon HG, Jeong BC, Jeon SS, Lee HM, Seo SIL. Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors. J Endourol 2020; 34:175-183. [DOI: 10.1089/end.2019.0410] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chang Il Choi
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong-si, Republic of Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong IL Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Cacciamani GE, Gill T, Medina L, Ashrafi A, Winter M, Sotelo R, Artibani W, Gill IS. Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis. J Urol 2018; 200:716-730. [DOI: 10.1016/j.juro.2018.04.079] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Urology, University of Verona, Verona, Italy
| | - Tania Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luis Medina
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Akbar Ashrafi
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew Winter
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Renè Sotelo
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Inderbir S. Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Marconi L, Challacombe B. Robotic Partial Nephrectomy for Posterior Renal Tumours: Retro or Transperitoneal Approach? Eur Urol Focus 2018; 4:632-635. [DOI: 10.1016/j.euf.2018.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/22/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023]
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Takagi T, Kondo T, Yoshida K, Kobayashi H, Iizuka J, Okumi M, Ishida H, Tanabe K. Comparison of Kidney Function in the Early Postoperative Period in Transperitoneal Robot-Assisted Laparoscopic Partial Nephrectomy Between Anterior and Posterior Renal Tumors: A Propensity Score-Matched Study. J Endourol 2017; 32:111-115. [PMID: 29092632 DOI: 10.1089/end.2017.0654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To compare early postoperative renal function in transperitoneal robot-assisted laparoscopic partial nephrectomy (RAPN) for anterior and posterior renal tumors. PATIENTS AND METHODS This study included 227 patients who underwent transperitoneal RAPN for anterior or posterior renal tumors. Tumor position was defined by RENAL nephrometry score. To minimize selection bias between anterior and posterior tumors, patient variables were adjusted using 1:1 propensity score matching. RESULTS Of the 227 patients, 125 were classified as having anterior tumors and 102 as having posterior tumors. After matching, 82 patients were included in each group. The mean preoperative estimated glomerular filtration rate (eGFR) was 66 mL/min/1.73 m2. The mean tumor size was 28 to 29 mm. The decrease in early postoperative nadir eGFR (-10% vs -4.0%, p = 0.0103) was significantly higher for posterior tumors than for anterior tumors. However, the difference improved 6 to 12 months after surgery (-6.0% vs -6.2%, p = 0.9564). The other surgical outcomes, including operative time, warm ischemia time (WIT), complications, surgical margin status, and length of hospital stay, were not significantly different between the two groups. In multivariate analysis of the entire cohort, posterior tumors (vs anterior tumor, odds ratio [OR]: 2.30, p = 0.0051), longer WIT (OR: 3.10, p = 0.0019), and high tumor complexity (vs low complexity, OR: 3.46, p = 0.0264) were independent predictors for development of a 10% decrease in early postoperative eGFR. CONCLUSIONS Posterior tumors had a greater decrease in early postoperative nadir eGFR than anterior tumors, with equivalent surgical outcomes, including similar renal function, 6 to 12 months after surgery in the setting of transperitoneal RAPN.
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Affiliation(s)
- Toshio Takagi
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Tsunenori Kondo
- 2 Department of Urology, Tokyo Women's Medical University Medical Center East , Tokyo, Japan
| | - Kazuhiko Yoshida
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Hirohito Kobayashi
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Junpei Iizuka
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Masayoshi Okumi
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Hideki Ishida
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
| | - Kazunari Tanabe
- 1 Department of Urology, Tokyo Women's Medical University , Tokyo, Japan
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Maurice MJ, Kaouk JH, Ramirez D, Bhayani SB, Allaf ME, Rogers CG, Stifelman MD. Robotic Partial Nephrectomy for Posterior Tumors Through a Retroperitoneal Approach Offers Decreased Length of Stay Compared with the Transperitoneal Approach: A Propensity-Matched Analysis. J Endourol 2017; 31:158-162. [PMID: 27927035 DOI: 10.1089/end.2016.0603] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION We sought to compare surgical outcomes between transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) for posterior tumors. PATIENTS AND METHODS Using our multi-institutional RPN database, we reviewed 610 consecutive cases for posterior renal masses treated between 2007 and 2015. Primary outcomes were complications, operative time, length of stay (LOS), surgical margin status, and estimated glomerular filtration rate (eGFR) preservation. Secondary outcomes were estimated blood loss, warm ischemia time (WIT), disease recurrence, and disease-specific mortality. Due to significant differences in treatment year and tumor size between approaches, retroperitoneal cases were matched 1:4 to transperitoneal cases based on propensity scores using the greedy algorithm. Outcomes were compared between approaches using the chi-square and Mann-Whitney U tests. RESULTS After matching, 296 transperitoneal and 74 retroperitoneal cases were available for analysis, and matched groups were well balanced in terms of treatment year, age, gender, race, American Society of Anesthesiologists physical status classification (ASA) score, body mass index, tumor laterality, tumor size, R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus, anterior/posterior, location relative to polar lines) score, and hilar location. Compared with transperitoneal, the retroperitoneal approach was associated with significantly shorter mean LOS (2.2 vs 2.6 days, p = 0.01), but longer mean WIT (21 vs 19 minutes, p = 0.01). Intraoperative (p = 0.35) and postoperative complications (p = 0.65), operative time (p = 0.93), positive margins (p = 1.0), and latest eGFR preservation (p = 0.25) were not significantly different between approaches. No differences were detected in the other outcomes. CONCLUSIONS Among high-volume surgeons, transperitoneal and retroperitoneal RPN achieved similar outcomes for posterior renal masses, although with slight differences in LOS and WIT. Retroperitoneal RPN may be an effective option for the treatment of certain small posterior renal masses.
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Affiliation(s)
- Matthew J Maurice
- 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Daniel Ramirez
- 1 Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Sam B Bhayani
- 2 Division of Urology, Washington University School of Medicine , St. Louis, Missouri
| | - Mohamad E Allaf
- 3 James Buchanan Brady Urological Institute , Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Craig G Rogers
- 4 Vattikuti Urology Institute , Henry Ford Hospital, Detroit, Michigan
| | - Michael D Stifelman
- 5 Department of Urology, Hackensack University Medical Center , Hackensack, New Jersey
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Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: A systematic review and meta-analysis. Int J Surg 2016; 30:109-15. [DOI: 10.1016/j.ijsu.2016.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 02/01/2023]
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Paulucci DJ, Whalen MJ, Badani KK. Analysis of the Transperitoneal Approach to Robot-Assisted Laparoscopic Partial Nephrectomy for the Treatment of Anterior and Posterior Renal Masses. J Laparoendosc Adv Surg Tech A 2015; 25:880-5. [DOI: 10.1089/lap.2015.0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- David J. Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Michael J. Whalen
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Ketan K. Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Harris KT, Ball MW, Gorin MA, Allaf ME, Pierorazio PM. Outcomes of partial nephrectomy in patients who meet percutaneous ablation criteria. Cent European J Urol 2015; 68:132-6. [PMID: 26251725 PMCID: PMC4526608 DOI: 10.5173/ceju.2015.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/04/2015] [Accepted: 02/01/2015] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Treatment options for small renal masses include partial nephrectomy (PN), ablation and active surveillance. We sought to compare patients who met the criteria for percutaneous ablation but underwent robotic PN to the rest of our robotic PN cohort. This was done in order to detect any safety concerns and to define any risk factors that might contraindicate the use of robotic PN, an oncologically superior procedure, in patients who qualify for ablation. MATERIAL AND METHODS Our departmental renal mass registry was queried for patients who underwent robotic PN but also met criteria for percutaneous ablation. These were compared to the rest of the robotic PN cohort. Demographics, perioperative characteristics and recurrence data were compared. RESULTS Overall, 321 robotic PNs were identified. Of these, 26 (8.1%) met ablation criteria. Among patient characteristics, age and BMI were similar in both groups. Among operative characteristics, estimated blood loss (EBL) and operative time were similar. Warm ischemia time was significantly less for patients who met ablation criteria (14 vs. 17 minutes, p = 0.002). Mean tumor size was smaller for patients who met ablation criteria (2.3 vs. 2.7 cm, p = 0.012). Among postoperative characteristics, complications were similar overall and when present, stratified by Clavien grade. CONCLUSIONS Robotic PN is a safe, effective treatment option for small renal masses, even in patients who meet ablation criteria. There were no recurrences in our cohort and the majority of complications were Clavien grade 1.
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Affiliation(s)
- Kelly T Harris
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Usefulness of the diameter–axial–polar nephrometry score for predicting perioperative parameters in robotic partial nephrectomy. World J Urol 2014; 33:841-5. [DOI: 10.1007/s00345-014-1372-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/29/2014] [Indexed: 01/20/2023] Open
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Kardos SV, Gross CP, Shah ND, Schulam PG, Trinh QD, Smaldone MC, Sun M, Weight CJ, Sammon J, Han LC, Kim SP. Association of type of renal surgery and access to robotic technology for kidney cancer: results from a population-based cohort. BJU Int 2014; 114:549-54. [DOI: 10.1111/bju.12711] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Steven V. Kardos
- Department of Urology; Public Policy and Effectiveness Research Center; New Haven CT
| | - Cary P. Gross
- Cancer Outcomes; Public Policy and Effectiveness Research Center; New Haven CT
- Department of Internal Medicine; Yale University; New Haven CT
| | - Nilay D. Shah
- Division of Health Care and Policy Research; Mayo Clinic; Rochester
| | - Peter G. Schulam
- Department of Urology; Public Policy and Effectiveness Research Center; New Haven CT
| | - Quoc-Dien Trinh
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA
| | - Marc C. Smaldone
- Department of Surgery; Fox Chase Cancer Center-Temple University Health System; Philadelphia PA
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes
- Department of Public Health; University of Montreal Health Center; Montreal QC Canada
| | | | - Jesse Sammon
- Department of Urology; Henry Ford Health System; Detroit MI USA
| | - Leona C. Han
- Division of Health Care and Policy Research; Mayo Clinic; Rochester
| | - Simon P. Kim
- Department of Urology; Public Policy and Effectiveness Research Center; New Haven CT
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