1
|
Okhawere KE, Rich JM, Beksac AT, Zuluaga L, Saini I, Ucpinar B, Levieddin J, Joel IT, Deluxe A, Stifelman MD, Crivellaro S, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Mansour A, Pierorazio PM, Zaytoun O, Badani KK. Transperitoneal Versus Retroperitoneal Robotic-Assisted Partial Nephrectomy in Patients with Obesity. J Laparoendosc Adv Surg Tech A 2023; 33:835-840. [PMID: 37339434 DOI: 10.1089/lap.2023.0142] [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] [Indexed: 06/22/2023] Open
Abstract
Introduction: We aim to compare transperitoneal (TP) and retroperitoneal (RP) robotic partial nephrectomy (RPN) in obese patients. Obesity and RP fat can complicate RPN, especially in the RP approach where working space is limited. Materials and Methods: Using a multi-institutional database, we analyzed 468 obese patients undergoing RPN for a renal mass (86 [18.38%] RP, 382 [81.62%] TP). Obesity was defined as body mass index ≥30 kg/m2*. A 1:1 propensity score matching was performed adjusting for age, previous abdominal surgery, tumor size, R.E.N.A.L nephrometry score, tumor location, surgical date, and participating centers. Baseline characteristics and perioperative and postoperative data were compared. Results: In the propensity score-matched cohort, 79 (50%) TP patients were matched with 79 (50%) RP patients. The RP group had more posterior tumors (67 [84.81%], RP versus 23 [29.11%], TP; P < .001), while the other baseline characteristics were comparable. Warm ischemia time (interquartile range; 15 [10, 12], RP versus 14 [10, 17] minutes, TP; P = .216), operative time (129 [116, 165], RP versus 130 [95, 180] minutes, TP; P = .687), estimated blood loss (50 [50, 100], RP versus 75 [50, 150] mL, TP; P = .129), length of stay (1 [1, 1], RP versus 1 [1, 2] day, TP; P = .319), and major complication rate (1 [1.27%], RP versus 3 [3.80%], TP; P = .620) were similar. No significant difference was observed in positive surgical margin rate and delta estimated glomerular filtration at follow-up. Conclusion: TP and RP RPN yielded similar perioperative and postoperative outcomes in obese patients. Obesity should not be a factor in determining optimal approach for RPN.
Collapse
Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jordan Miller Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alp Tuna Beksac
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Levieddin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iretiayo T Joel
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | - Anthony Deluxe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois, Chicago, Illinois, USA
| | | | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, Washington, USA
| | - Ahmed Mansour
- Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Phillip M Pierorazio
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
2
|
Hsieh CC, Tseng WH, Liu CL, Su CC, Li CF, Ho CH, Huang SK, Chiu AW. Early Postoperative Outcomes of Retroperitoneal Partial Nephrectomy of Anterior and Posterior Renal Tumors: A Five-year Experience in A Single Center. J Endourol 2023; 37:557-563. [PMID: 36927036 DOI: 10.1089/end.2022.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE Partial nephrectomy (PN) is one of the surgical treatment options for renal tumors. Therefore, the aim of this study was to compare the surgical outcomes of retroperitoneal PN for anterior and posterior tumors. MATERIALS AND METHODS This study enrolled 177 patients who had renal tumors that were detected on abdominal computed tomography and underwent PN between January 2017 and April 2021. Tumor position was defined by the anatomic avascular Brodel's line. Surgical outcomes were compared between approaches using the chi-squared, Student's t-tests, logistic regression analysis and stratification analysis. RESULTS Of the 177 patients, 97 (54.8%) patients had anterior renal tumors and 80 (45.2%) had posterior renal tumors. On comparing the surgical results between the two groups, the anterior group had higher levels of hemoglobin (Hb) reduction (-1.92 g/dL vs. -1.54 g/dL, p = 0.0444), but the estimated blood loss showed no significant difference between the two groups (497.6 mL vs. 433.2 mL, p = 0.4149). In addition, the alter in estimated glomerular filtration rate (eGFR) at post-operative 1st day (p = 0.5616), 6th month (p = 0.5046) and at post-operative 1st year (p = 0.7085) were not significantly different between the two groups. Other surgical outcomes, such as blood transfusion rate, complications, and lengths of stay, also had no significant difference. Stratified analysis revealed the anterior renal tumors had a 3.76 times risk (p = 0.0186) than the posterior tumors for decreasing Hb > 10% under laparoscopic PN. No post-operative gastrointestinal-related complications were reported. CONCLUSIONS This study demonstrated retroperitoneal surgical access to renal tumors and revealed equivalent surgical outcomes for both anterior and posterior renal tumors. Moreover, anterior renal tumors had benefits under robotic PN for bleeding control. Retroperitoneal PN can be considered a good approach for both anterior and posterior renal tumors with few intra-abdominal complications.
Collapse
Affiliation(s)
- Chia-Chih Hsieh
- Chi Mei Medical Center, 38018, Division of Urology, Department of Surgery, Tainan, Taiwan;
| | - Wen-Hsin Tseng
- Chi Mei Medical Center, 38018, Division of Urology, Department of Surgery, Tainan, Taiwan.,National Sun Yat-sen University, 34874, Institute of Biomedical Science, Kaohsiung, Taiwan;
| | - Chien-Liang Liu
- Chi Mei Medical Center, 38018, urology, No.901, Zhonghua Rd., Yongkang Dist., Tainan City 71004, Taiwan (R.O.C.), Yung Kang, Tainan City, Taiwan, 704;
| | - Chia-Cheng Su
- Chi Mei Medical Center, 38018, Division of Urology, Department of Surgery, Tainan, Taiwan;
| | - Chien-Feng Li
- Chi Mei Medical Center, 38018, Department of Pathology, Tainan, Taiwan;
| | - Chung-Han Ho
- Chi Mei Medical Center, 38018, Department of Medical Research, Tainan, Taiwan;
| | | | - Allen W Chiu
- Taipei City Hospital Renai Branch, 156947, Urology, Taipei, Taiwan.,Mackay Memorial Hospital, 36897, urology, Taipei, Taiwan.,National Yang Ming Chiao Tung University, 34914, Urology, Taipei, Taiwan;
| |
Collapse
|
3
|
A comparison of outcomes between transperitoneal and retroperitoneal robotic assisted partial nephrectomy in patients with completely endophytic kidney tumors. Urol Oncol 2023; 41:111.e1-111.e6. [PMID: 36528472 DOI: 10.1016/j.urolonc.2022.11.023] [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: 09/09/2022] [Revised: 10/16/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Retroperitoneal robotic partial nephrectomy (RPN) has been shown to have comparable outcomes to the transperitoneal approach for renal tumors. However, this may not be true for completely endophytic tumors as they pose significant challenges in RPN with increased complication rates. Hence, we sought to compare the safety and feasibility of retroperitoneal RPN to transperitoneal RPN for completely endophytic tumors. METHODS We performed a retrospective analysis of patients who underwent RPN for a completely endophytic renal mass using either transperitoneal or retroperitoneal approach from our multi-institutional database (n = 177). Patients who had a solitary kidney, prior ipsilateral surgery, multiple/bilateral tumors, and horseshoe kidneys were excluded from the analysis. Overall, 156 patients were evaluated (112 [71.8%] transperitoneal, 44 [28.2%] retroperitoneal). Baseline characteristics, perioperative and postoperative data were compared between the surgical transperitoneal and retroperitoneal approach using Chi-square test, Fishers exact test, t test, Mood median test and Mann Whitney U test. RESULTS Of the 156 patients in this study, 86 (56.9%) were male and the mean (SD) age was 58 (13) years. Baseline characteristics were comparable between the 2 approaches. Compared to transperitoneal approach, retroperitoneal approach had similar ischemia time (19.6 [SD = 7.6] minutes vs. 19.5 [SD = 10.2] minutes, P = 0.952), operative time (157.5 [SD = 44.8] minutes vs. 160.2 [SD = 47.3] minutes, P = 0.746), median estimated blood loss (50 ml [IQR: 50, 150] vs. 100 ml [IQR: 50, 200], P = 0.313), median length of stay (1 [IQR: 1, 2] day vs. 1 [IQR: 1, 2] day, P = 0.126) and major complication rate (2 [4.6%] vs. 3 [2.7%], P = 0.621). No difference was observed in positive surgical margin rate (P = 0.1.00), delta eGFR (P = 0.797) and de novo chronic kidney disease occurrence (P = 1.000). CONCLUSION Retroperitoneal and transperitoneal RPN yielded similar perioperative and functional outcomes in patients with completely endophytic tumors. In well-selected patients with purely endophytic tumors, either a retroperitoneal or transperitoneal approach could be considered without compromising perioperative and postoperative outcomes.
Collapse
|
4
|
BAHÇECİ T. Urological laparoscopic procedures and results performed by a single urologist in a secondary state hospital. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1127748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: To evaluate the results of urological laparoscopic operations performed by a single surgeon in secondary public hospital
Materials and Methods: The data of 30 patients who underwent urological laparoscopic surgery in Şanlıurfa Training and Research Hospital between January 2018 and January 2021 were retrospectively analyzed. The operation type, duration of operation, side, removal time of drain, length of stay in the hospital and complications were noted.
Results: All patients underwent laparoscopy via transperitoneal route. Laparoscopic nephrectomy was performed in 15 patients, dismembred pyeloplasty in 4 patients, ureterolithotomy in 8 patients, and cyst excision in 3 patients. The mean patient age was 40.43 + 16.72 (14-76). A male/female ratio of 13/17 was found to be 43.3% male and 56.7% female. Considering the operation times, nephrectomy was 173.26 (120-240) minutes, pyeloplasty 240 ± (210-270) minutes, ureterolithotomy 110.75 (75-180) minutes, and cyst excision 112.66 (100-138) minutes. All patients had a trace amount of drains (
Collapse
Affiliation(s)
- Tuncer BAHÇECİ
- Şanlıurfa Eğitim ve Araştırma Hastanesi, Şanlıurfa, Türkiye
| |
Collapse
|
5
|
Garg H, Yadav S, Singh P, Hemal A, Kumar R. Retroperitoneoscopic nephrectomy: current status. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820956431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The classic retroperitoneal open surgical access to the kidney has been duplicated while performing laparoscopy but is less common than transperitoneal laparoscopy. We reviewed minimally invasive retroperitoneoscopic nephrectomy as a part of the international consultation on urological diseases and European Association of Urology international consultation on minimally invasive surgery in urology. A Pubmed/Medline search was performed to identify studies assessing the feasibility, safety and efficacy of laparoscopic and robotic retroperitoneoscopic nephrectomy. The articles were reviewed to assess outcomes after simple, radical and donor nephrectomy and comparative trials between retroperitoneoscopic versus the open and transperitoneal route were evaluated. Retroperitoneoscopic nephrectomy is feasible for most cases of benign non-functioning kidneys. Retroperitoneoscopic radical nephrectomy is also feasible for most tumours and may be better suited for posteriorly located tumours. Both retroperitoneoscopic and transperitoneal nephrectomy have similar outcomes but the operative time may be shorter for the former. The data are insufficient for robotic retroperitoneoscopic nephrectomy probably because of limited space and lack of benefit of a robot in ablative surgeries. Level of evidence: 3a
Collapse
Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
| | - Siddharth Yadav
- Department of Urology, Sajdarjung Hospital and Vardhman Mahavir Medical College, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
| | - Ashok Hemal
- Department of Urology, Wake Forest School of Medicine, USA
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
| |
Collapse
|
6
|
Aydin C, Akkoc A, Aydin ZB. How safe and effective is stentless laparoscopic ureterolithotomy in elderly patients? Int J Clin Pract 2021; 75:e14308. [PMID: 33928719 DOI: 10.1111/ijcp.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the improvement of minimally invasive urology procedures, open surgical interventions are less common to treat ureteral calculus. Laparoscopic ureterolithotomy (LU) indications are large multiple and/or impacted ureteral calculus that may not be treated with shock-wave lithotripsy or ureterorenoscopy approaches. The aim of our study was to investigate the feasibility and safety of stentless LU in elderly patients. METHODS Between October 2011 and December 2019, 38 geriatric patients underwent stentless transperitoneal LU for upper/mid ureteral calculi. The transperitoneal route was applied in all patients by two surgeons. No double J stent inserted in any patient. The data of all patients reviewed retrospectively. RESULTS The average age was 64.60 ± 3.70 years. The mean calculi size was 19.42 ± 1.41 mm. Ten patients had unsuccessful shock wave lithotripsy or ureterorenoscopy history. The calculi-free rate was 100%. Clavien grade 1 complications were seen in 11 (28.9%) cases. No major perioperative and postoperative complications were encountered. The average length of hospital stay was 3.24 ± 1.53 days. CONCLUSION The significant advances in medical technology and healthcare, lead a rising number of geriatric patients to take benefit of even complicated surgery. Although laparoscopy and its safety in the geriatric population pursues a challenge and the assessment of this procedure is hence obligatory, we think that stentless LU is safe, economical and less uncomfortable for elderly patients.
Collapse
Affiliation(s)
- Cemil Aydin
- Department of Urology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
| | - Ali Akkoc
- Department of Urology, Alaaddin Keykubat University School of Medicine, Training and Research Hospital, Alanya, Turkey
| | - Zeynep Banu Aydin
- Department of Radiology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
| |
Collapse
|
7
|
Strauss DM, Lee R, Maffucci F, Abbott D, Masic S, Kutikov A. The future of "Retro" robotic partial nephrectomy. Transl Androl Urol 2021; 10:2199-2208. [PMID: 34159103 PMCID: PMC8185662 DOI: 10.21037/tau.2019.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Partial nephrectomy (PN) is the gold standard treatment for appropriately selected renal masses. Recent surgical advancements and adoption of the robotic technique has led to greater adoption of nephron-sparing surgery. Robotic PN was initially described via the transperitoneal (TP) approach, however, retroperitoneal (RP) access is possible and in some cases more desirable. In the RP approach, the kidney is accessed from its posterior surface and the intraperitoneal space is avoided. The RP approach to PN has the benefit of avoiding intraperitoneal viscera and colonic mobilization in patients with extensive prior abdominal surgery. The technique also eliminates the need for renal unit rotation in patients with posterior tumors and affords access to masses directly posterior to the renal hilum. The RP and TP approach to PN have shown similar oncologic and perioperative outcomes. Several recent studies have reported shorter operative times and lengths of stay (LOS) with comparable warm ischemia times for the RP approach when compared to transperitoneal PN (tPN). Given the indispensable deliverables of this approach in select patients, robotic retroperitoneal PN (rPN) should be in the armamentarium of a versatile urologic kidney surgeon. This review describes the current state of rPN and compares the indications and outcomes of the TP and RP approaches.
Collapse
Affiliation(s)
- David M Strauss
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Randall Lee
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Fenizia Maffucci
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Daniel Abbott
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Selma Masic
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| |
Collapse
|
8
|
Bernabei M, Di Domenico A, Falcao G, Fragkoulis C, Benelli A, Beverini M, Pinheiro LC, Carneiro C, Fabbri N, Glykas I, Greco S, Introini C, Ntoumas K, Papadopoulos G, Rutigliani M, Stamatakos P, Barreira JV. Oncological cases and complications in Urology. ACTA ACUST UNITED AC 2021; 93:77-81. [PMID: 33754614 DOI: 10.4081/aiua.2021.1.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 02/08/2023]
Abstract
This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of left hydronephrosis referred four years after a right radical mastectomy for lobular breast carcinoma was described. Computed tomography scan revealed a left hydronephrosis with dilated ureter up to the proximal third. An exploratory laparoscopy was performed and the definitive histopathology examination showed a recurrence of the carcinoma with a right tubal metastasis and peritoneal carcinosis. Case 2: A rare case of an extensive penile squamous cell carcinoma in a young man. The patient was treated with radical surgery and modified inguinal lymphadenectomy. No recurrence was noticed so far. Case 3: A rare case of left sided Inferior Vena Cava (IVC) in a patient diagnosed with renal cell cancer who underwent open left partial nephrectomy. Case 4: A case of urethrorrhagia, caused by a recent trauma from an urinary catheter placed in a patient submitted to gastric resection due to a neoplastic pathology. Urethrorrhagia only temporarily responded to conservative treatment and ultimately resolved by coagulation with an endoscopic approach.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Nicolò Fabbri
- Unit of General Surgery, Azienda Unità Sanitaria Locale di Ferrara, Lagosanto.
| | - Ioannis Glykas
- Urology Department, General Hospital of Athens "G. Gennimatas", Athens.
| | - Salvatore Greco
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara.
| | | | | | | | | | | | | |
Collapse
|
9
|
Lee HH, Yoon YE, Kim YS, Na JC, Rha KH, Han WK, Kim DK. Retroperitoneal single-site robot-assisted partial nephrectomy using Lapsingle Vision advanced access platform: initial three case reports. Transl Androl Urol 2020; 9:758-765. [PMID: 32420181 PMCID: PMC7215040 DOI: 10.21037/tau.2020.01.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Robot-assisted partial nephrectomy is currently the standard for treatment of small renal mass. Recently, robot-assisted single site surgery has been introduced. However, there have been few reports of retroperitoneal approaches. Herein, we report initial case series of retroperitoneal single-site robot-assisted partial nephrectomy using the da Vinci Xi surgical system using the Lapsingle Vision advanced access platform. Three patients have undergone retroperitoneal single-site robot-assisted partial nephrectomy due to incidental finding of renal mass. Operation duration, estimated blood loss, warm ischemia time, estimated glomerular filtration rate (eGFR) change, and complication were evaluated. Renal cell carcinoma of the two clear cell type and one chromophobe was diagnosed based on the pathological examination. Initial two cases were successfully completed with minimal bleeding and warm ischemic time within 25 minutes. The last 3rd case has been converted to multiport operation due to limited retroperitoneal space and difficulty in managing upper pole renal mass. Retroperitoneal single-site robot-assisted partial nephrectomy is a feasible treatment modality for treatment of posterior or lateral renal masses. Additional cases are needed to confirm the safety and efficacy of this technique.
Collapse
Affiliation(s)
- Hyung Ho Lee
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Sig Kim
- Department of Urology, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Joon Chae Na
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing. Curr Opin Urol 2019; 28:108-114. [PMID: 29278580 DOI: 10.1097/mou.0000000000000483] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC. RECENT FINDINGS Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P = 0.490), sex (P = 0.715), BMI (P = 0.273), and comorbidity (P = 0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P = 0.001) and length of stay (LOS) (1.8 versus 2.7 days, P < 0.001). There were no differences in renal function preservation or cancer control. In adjusted analyses, retroperitoneal RALPN was 17.6-min shorter (P < 0.001) and had a 76% lower probability of LOS at least 2 days (P < 0.001). Utilizing TDABC, transperitoneal RALPN added $2337 in cost when factoring in disposable equipment, operative time, LOS, and personnel. SUMMARY In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.
Collapse
|
11
|
Yumoto T, Kondo Y, Kumon K, Masaoka Y, Hiraki T, Yamada T, Naito H, Nakao A. Delayed hydronephrosis due to retroperitoneal hematoma after a seatbelt injury: A case report. Medicine (Baltimore) 2018; 97:e11022. [PMID: 29879068 PMCID: PMC5999472 DOI: 10.1097/md.0000000000011022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. PATIENT CONCERNS A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. DIAGNOSES CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. INTERVENTIONS Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. OUTCOMES His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. LESSONS Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.
Collapse
Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kento Kumon
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Taihei Yamada
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| |
Collapse
|
12
|
Ma L, Yu Y, Ge G, Li G. Laparoscopic nephrectomy outside gerota fascia and En bloc ligation of the renal hilum for management of inflammatory renal diseases. Int Braz J Urol 2018; 44:280-287. [PMID: 29144627 PMCID: PMC6050554 DOI: 10.1590/s1677-5538.ibju.2017.0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/13/2017] [Indexed: 05/29/2023] Open
Abstract
Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.
Collapse
Affiliation(s)
- Liang Ma
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yanlan Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Guangju Ge
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Chen Y, Zheng H, Liang G, Wang D, Qiu J, Fang Y. Comparison of Transperitoneal and Retroperitoneal Laparoscopic Nephrectomy for Nonfunctional Tuberculous Kidneys: A Single-Center Experience. J Laparoendosc Adv Surg Tech A 2017; 28:325-329. [PMID: 28657827 DOI: 10.1089/lap.2017.0270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and safety between retroperitoneal laparoscopic nephrectomy (RLN) and transperitoneal laparoscopic nephrectomy (TLN) for nonfunctional tuberculous kidneys (NTK). METHODS From March 2013 to February 2016, 24 patients with NTK underwent laparoscopic nephrectomy in our department. Eleven patients underwent RLN, and 13 underwent TLN. The demographics and perioperative outcomes were compared retrospectively. RESULTS Characteristics, including gender, age, body mass index, and location, were similar in these two groups. All operations were successfully completed in the RLN group, while 1 case in the TLN group was converted to open surgery due to severe adhesions and excessive bleeding (1 of 13 patients). Time to oral intake after surgery in the TLN and RLN group was 43.85 ± 6.01 hours and 27.45 ± 6.83 hours (P < .05). No notable differences were found between two groups in terms of estimated blood loss, operative time, days of drain removal, and postoperative hospital stay. No local or disseminated recurrence was identified during the follow-up period. CONCLUSION Taking the same safety and effectiveness into consideration, TLN can be an alternative choice for experienced surgeons to deal with NTK. Also, further studies with a larger sample size should be performed to confirm this finding.
Collapse
Affiliation(s)
- Yanxiong Chen
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Haofeng Zheng
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Guancan Liang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Dejuan Wang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Jianguang Qiu
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| | - Youqiang Fang
- Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong Province, China
| |
Collapse
|
15
|
Kim HY, Choe HS, Lee DS, Yoo JM, Lee SJ. Extending the indication for robot-assisted retroperitoneal partial nephrectomy to antero-lateral renal tumors. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Hee Youn Kim
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Hyun-Sop Choe
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Jae Mo Yoo
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| |
Collapse
|
16
|
Retroperitoneal Versus Transperitoneal Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2016; 30:239-44. [PMID: 26960305 DOI: 10.1016/s1001-9294(16)30007-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy (RLPN) with transperitoneal laparoscopic partial nephrectomy (TLPN) and provide reference for clinical work. METHODS The search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate. RESULTS The literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference (MD)=-33.68, 95% confidence interval (CI) within (-60.35, -7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within (-2.18, -0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes. CONCLUSIONS RLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.
Collapse
|
17
|
Lim IIP, Honeyman JN, Fialkowski EA, Murphy JM, Price AP, Abramson SJ, Quaglia MPL, Heaton TE. Experience with retroperitoneal partial nephrectomy in bilateral Wilms tumor. Eur J Pediatr Surg 2015; 25:113-7. [PMID: 25181295 PMCID: PMC7537816 DOI: 10.1055/s-0034-1387944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Retroperitoneal partial nephrectomy has not been studied as a surgical approach for children with bilateral Wilms tumor. There are advantages to this technique, including isolation of urine leaks to the retroperitoneum, decreased risk of bowel injury, and decreased time to resuming a diet. Presently, all bilateral Wilms tumors are treated with neoadjuvant chemotherapy and attempted nephron-sparing surgery. In this study, we compare the outcomes of the retroperitoneal and transabdominal approaches in doing partial nephrectomy for bilateral Wilms tumor. METHODS With the institutional review board approval, we reviewed records of 14 pediatric patients with metachronous or synchronous bilateral Wilms tumors who underwent surgery after chemotherapy between 1994 and 2014. Only operative procedures with the intent to cure were included (n=15) and of these, 5 procedures were retroperitoneal and 10 were transabdominal in approach. Individual kidneys operated upon (n=26) were analyzed using the preoperative radius exophytic/endophytic nearness anterior/posterior location nephrometry score to ensure that resected tumors were comparable between the two surgical groups. Charts were retrospectively analyzed for intraoperative parameters and postoperative course. Differences between parameters were evaluated using Mann-Whitney and chi-square tests. RESULTS Resected tumors in both surgical treatment groups had comparable sizes, nephrometry scores, and rates of anaplasia. Operative time, blood loss, and transfusion requirement were similar between the two groups. The extent of lymph node sampling and rates of R0 resection were equivalent. One adverse intraoperative event, a bowel enterotomy, was seen in the transabdominal group. Patients after retroperitoneal partial nephrectomy required half the time to return to an oral diet as compared with those after a transabdominal surgery, approaching statistical significance (p=0.08). Rates of the postoperative urine leak were similar, though two in the transabdominal group required reoperation for drainage. There were four recurrences, all in the transabdominal group. CONCLUSION Our experience demonstrates that the retroperitoneal approach is equivalent to the transabdominal technique with regards to intraoperative complications, lymph node dissection, and R0 resection. Advantages include less time to resumption of oral feeding, decreased risk of bowel injury, and isolation of urine leaks to the retroperitoneum. It should be considered a viable surgical option in the treatment of bilateral Wilms tumors.
Collapse
Affiliation(s)
- Irene Isabel P. Lim
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua N. Honeyman
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A. Fialkowski
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer M. Murphy
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anita P. Price
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sara J. Abramson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael P. La Quaglia
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Todd E. Heaton
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
18
|
Canter DJ, Cahn DB, Uzzo RG. Surgical Approaches to Early-Stage Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Hu JC, Treat E, Filson CP, McLaren I, Xiong S, Stepanian S, Hafez KS, Weizer AZ, Porter J. Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. Eur Urol 2014; 66:542-9. [PMID: 24857539 DOI: 10.1016/j.eururo.2014.04.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/26/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Robot-assisted retroperitoneoscopic partial nephrectomy (RARPN) may be used for posterior renal masses or with prior abdominal surgery; however, there is relatively less familiarity with RARPN. OBJECTIVE To demonstrate RARPN technique and outcomes. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter study of 227 consecutive RARPNs was performed at the Swedish Medical Center, the University of Michigan, and the University of California, Los Angeles, from 2006 to 2013. SURGICAL PROCEDURE RARPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed positive margins and cancer recurrence. Stepwise regression was used to examine factors associated with complications, estimated blood loss (EBL), warm ischemia time (WIT), operative time (OT), and length of stay (LOS). RESULTS AND LIMITATIONS The median age was 60 yr (interquartile range [IQR]: 52-66), and the median body mass index (BMI) was 28.2 kg/m(2) (IQR: 25.6-32.6). Median maximum tumor diameter was 2.3 cm (IQR: 1.7-3.1). Median OT and WIT were 165 min (IQR: 134-200) and 19 min (IQR: 16-24), respectively; median EBL was 75 ml (IQR: 50-150), and median LOS was 2 d (IQR: 1-3). Twenty-eight subjects (12.3%) experienced complications, three (1.3%) had urine leaks, and three (1.3%) had pseudoaneurysms that required reintervention. There was one conversion to radical nephrectomy and three transfusions. Overall, 143 clear cell carcinomas (62.6%) composed most of the histology with eight positive margins (3.5%) and two recurrences (0.9%) with a median follow-up of 2.7 yr. In adjusted analyses, intersurgeon variation was associated with complications (odds ratio [OR]: 3.66; 95% confidence interval, 1.31-10.27; p = 0.014) and WIT (parameter estimate [PE; plus or minus standard error]: 4.84 ± 2.14; p = 0.025). Higher surgeon volume was associated with shorter WIT (PE: -0.06 ± 0.02; p = 0.002). Higher BMI was associated with longer OT (PE: 2.09 ± 0.56; p < 0.001). Longer OT was associated with longer LOS (PE: 0.01 ± 0.01; p = 0.002). Finally, there was a trend for intersurgeon variation in OT (PE: 18.5 ± 10.3; p = 0.075). CONCLUSIONS RARPN has acceptable morbidity and oncologic outcomes, despite intersurgeon variation in WIT and complications. Greater experience is associated with shorter WIT. PATIENT SUMMARY Robot-assisted retroperitoneoscopic partial nephrectomy has acceptable morbidity and oncologic outcomes, and there is intersurgeon variation in warm ischemia time and complications.
Collapse
Affiliation(s)
- Jim C Hu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Eric Treat
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christopher P Filson
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ian McLaren
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Siwei Xiong
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Khaled S Hafez
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | |
Collapse
|
20
|
Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C, Ren M. Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One 2014; 9:e91978. [PMID: 24658032 PMCID: PMC3962363 DOI: 10.1371/journal.pone.0091978] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/16/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma and provide evidence-based medicine support for clinical treatment. METHODS A systematic computer search of PUBMED, EMBASE, and the Cochrane Library was executed to identify retrospective observational and prospective randomized controlled trials studies that compared the outcomes of the two approaches in laparoscopic partial nephrectomy. Two reviewers independently screened, extracted, and evaluated the included studies and executed statistical analysis by using software STATA 12.0. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables. RESULTS There were 8 studies assessed transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN) were included. RLPN had a shorter operating time (SMD = 1.001,95%confidence interval[CI] 0.609-1.393,P<0.001), a lower estimated blood loss (SMD = 0.403,95%CI 0.015-0.791,P = 0.042) and a shorter length of hospital stay (WMD = 0.936 DAYS,95%CI 0.609-1.263,P<0.001) than TLPN. There were no significant differences between the transperitoneal and retroperitoneal approaches in other outcomes of interest. CONCLUSIONS This meta-analysis indicates that, in appropriately selected patients, especially patients with intraperitoneal procedures history or posteriorly located renal tumors, the RLPN can shorten the operation time, reduce the estimated blood loss and shorten the length of hospital stay. RLPN may be equally safe and be faster compared with the TLPN.
Collapse
Affiliation(s)
- Tong Ren
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Yan Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Xiaowen Zhao
- Department of Health Economics, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Shaobin Ni
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Cheng Zhang
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Changgang Guo
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Minghua Ren
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
- * E-mail:
| |
Collapse
|
21
|
Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature. Surg Endosc 2013; 27:3021-7. [DOI: 10.1007/s00464-013-2845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
|
22
|
Lall C, Patel H, Fujimoto S, Sandhu S, Sundaram C, Landman J. Making sense of postoperative CT imaging following laparoscopic partial nephrectomy. Clin Radiol 2012; 67:675-86. [DOI: 10.1016/j.crad.2011.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/22/2011] [Accepted: 11/29/2011] [Indexed: 11/16/2022]
|
23
|
Canter D, Teper E, Smaldone M, Kutikov A, Uzzo RG. Surgical Approaches to Early Stage Kidney Cancer. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Marszalek M, Chromecki T, Al-Ali BM, Meixl H, Madersbacher S, Jeschke K, Pummer K, Zigeuner R. Laparoscopic partial nephrectomy: a matched-pair comparison of the transperitoneal versus the retroperitoneal approach. Urology 2011; 77:109-13. [PMID: 20970830 DOI: 10.1016/j.urology.2010.02.057] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 01/28/2010] [Accepted: 02/16/2010] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare surgical and functional results of both surgical approaches to endoscopic partial nephrectomy. It is currently performed either by the transperitoneal (t) or the retroperitoneal (r) approach. METHODS This was a retrospective, matched-pair comparison of 105 patients who underwent either transperitoneal laparoscopic (Graz) or retroperitoneoscopic (Klagenfurt) partial nephrectomy for clinical T1a renal masses. RESULTS A total of 35 patients after transperitoneal laparoscopic and 70 patients after retroperitoneoscopic partial nephrectomy were included to this analysis after matching for age (T: 59.3 vs R: 60.1 a), preoperative glomerular filtration rate (GFR) (T: 93.2 vs R: 96.1 mL/min) and tumor size (T: 2.4 vs R: 2.5 cm). Nephrometry scores were comparable between groups and were low, medium, and high in 54.3%, 45.7%, and 0% (t) and 55.7%, 42.9%, and 1.4% (r) of patients (P = .9). Operative time (T: 139.3 minutes vs. R: 83.9 minutes; P < .001) and hospitalization (T: 7 days, R: 5 days; P < .001) were shorter in the retroperitoneoscopic group. Ischemia time (T: 24.3 minutes, R: 22.6 minutes) and postsurgical GFR (T: 86.6 vs R: 90.0 mL/min), postsurgical GFR-decrease (T: 7.1%, R: 6.2%, P = .9) and decline of hemoglobin (T: 17.1%, R: 16.6%) were comparable. Complications were 4 nephrectomies (T: n = 1, R: n = 3), 2 revisions for hemorrhage (R: n = 2), 4 pneumothorax (R: n = 4), and 2 urinary fistulas (T: n = 2). The positive surgical margin rate was comparable between groups (T: n = 3, R: n = 5). CONCLUSIONS Transperitoneal laparoscopic and retroperitoneoscopic partial nephrectomy provide comparable surgical and functional results. One advantage of the retroperitoneoscopic access seems to be a shorter total surgical time.
Collapse
Affiliation(s)
- Martin Marszalek
- Department of Urology, Klagenfurt General Hospital, Klagenfurt, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Boggi U, Moretto C, Vistoli F, D'Imporzano S, Mosca F. Robotic suture of a large caval injury caused by endo-GIA stapler malfunction during laparoscopic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein. MINIM INVASIV THER 2010; 18:306-10. [PMID: 19707931 DOI: 10.1080/13645700903201001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary endo-GIA stapler malfunction occurred during robotic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein, in an obese woman diagnosed with single liver metastasis from a previous carcinoid tumour. Haemorrhage was soon controlled by clamping the vena cava below the injury using two wristed forceps angled at 90 degrees . With the two instruments locked in the holding position the ensuing operative strategy was discussed between surgeon and anaesthesia teams. Using the third robotic arm the caval injury was repaired laparoscopically with interrupted polypropylene sutures. The patient was transfused with two units of packed red blood cells, recovered uneventfully, and was discharged on post-operative day five. We conclude that even the most advanced technologies can fail and that surgeons should be fully aware of the consequences of these malfunctions and be prepared for repair. From this point of view, the da Vinci surgical system seems to have some advantages over classical laparoscopic methods including the ability to lock the wristed instruments in the holding position, the use of three arms by the same operating surgeon, and the extreme facilitation of intracorporeal suturing and knot-tying in deep and narrow spaces, extremely difficult if not impossible with conventional laparoscopic instruments.
Collapse
Affiliation(s)
- Ugo Boggi
- U.O. di Chirurgia Generale e Trapianti nell'Uremico e nel Diabetico, Azienda Ospedaliera, Universitaria pisana, Ospedale di Cisanello, via paradisa 2, 56124 Pisa, Italy.
| | | | | | | | | |
Collapse
|
26
|
Xie H, Teach JS, Burke AP, Lucchesi LD, Wu PC, Sarao RC. Laparoscopic repair of inferior vena caval injury using a chitosan-based hemostatic dressing. Am J Surg 2009; 197:510-4. [DOI: 10.1016/j.amjsurg.2007.12.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 12/19/2007] [Accepted: 12/19/2007] [Indexed: 10/21/2022]
|
27
|
Oh KJ, Kwon DD. Analysis of Surgical Results of Laparoscopic Partial Nephrectomy for Endophytic Renal Tumor. Chonnam Med J 2009. [DOI: 10.4068/cmj.2009.45.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
28
|
Taue R, Izaki H, Koizumi T, Kishimoto T, Oka N, Fukumori T, Takahashi M, Kanayama HO. Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparative study. Int J Urol 2008; 16:263-7. [PMID: 19087210 DOI: 10.1111/j.1442-2042.2008.02219.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ryuichi Taue
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Mejean A, Correas JM, Escudier B, de Fromont M, Lang H, Long JA, Neuzillet Y, Patard JJ, Piechaud T. [Kidney tumors]. Prog Urol 2007; 17:1101-44. [PMID: 18153989 DOI: 10.1016/s1166-7087(07)74782-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
30
|
Seo IY, Bae BJ, Rim JS. Early Experience of Laparoscopic Partial Nephrectomy for Renal Tumor. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ill Young Seo
- Department of Urology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Byung Jun Bae
- Department of Urology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Joung Sik Rim
- Department of Urology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| |
Collapse
|
31
|
Safi KC, Teber D, Moazen M, Anghel G, Maldonado RV, Rassweiler JJ. Laparoscopic Repair of External Iliac-Artery Transection During Laparoscopic Radical Prostatectomy. J Endourol 2006; 20:237-9; discussion 239. [PMID: 16646647 DOI: 10.1089/end.2006.20.237] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Vascular injuries are the most common complication of pelvic lymph-node dissection. We report a case of total division of the external iliac artery and its immediate laparoscopic repair. METHODS A 70-year-old man with a prostatic adenocarcinoma (Gleason Score 6) and serum prostate specific antigen concentration of 20 ng/mL had inadvertent external iliac-artery transection during pelvic lymphnode dissection secondary to the abnormal course and anatomy of the artery. Immediate laparoscopic repair was accomplished with a two-needle single-knot technique as is routinely used for the vesicourethral anastomosis. Thereafter, laparoscopic radical prostatectomy was completed. RESULTS The reconstruction time was 37 minutes. There was no significant blood loss. There were no further intraoperative complications. Postrepair, the femoral pulse was intact, and follow-up duplex color ultrasonography showed good flow. The patient was disharged home on day 7, ambulant and asymptomatic. CONCLUSION In controlled cicumstances, laparoscopic repair of external iliac-artery transection is feasible and represents a safe alternative to open surgery.
Collapse
Affiliation(s)
- Khalid C Safi
- SLK-Kliniken Heilbronn, Urology Department, Teaching Hospital, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
32
|
Rubio Briones J, Iborra Juan I, Casanova Ramón-Borja J, Solsona Narbón E. Nefrectomía radical laparoscópica. Actas Urol Esp 2006; 30:479-91. [PMID: 16884099 DOI: 10.1016/s0210-4806(06)73485-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, we review the different surgical approaches to carry out radical laparoscopic nephrectomy: transperitoneal approach, retroperitoneal approach and hand-assisted approach. We describe the advantages and drawbacks of each alternative and summarize the most important references in the medical literature. In spite of this being a relatively new surgical approach, less than 15 years old, it has become a standard treatment and, today, is considered as the elective surgical treatment for T1 and T2 renal tumours in many centres.
Collapse
Affiliation(s)
- J Rubio Briones
- Servicio de Urología, Instituto Valenciano de Oncología, Valencia.
| | | | | | | |
Collapse
|
33
|
|
34
|
Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000160630.81978.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Sáez-Martín L, Riera-Del Moral L, Gutiérrez-Nistal M, Aguilera A, Stefanov S, Riera de Cubas L. Ligadura accidental de arteria mesentérica superior como complicación de nefrectomía mediante cirugía laparoscópica. ANGIOLOGIA 2005. [DOI: 10.1016/s0003-3170(05)74920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|