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Franco A, Riolo S, Tema G, Guidotti A, Brassetti A, Anceschi U, Bove AM, D’Annunzio S, Ferriero M, Mastroianni R, Misuraca L, Guaglianone S, Tuderti G, Leonardo C, Cicione A, Licari LC, Bologna E, Flammia RS, Nacchia A, Trucchi A, Lombardo R, Franco G, Tubaro A, Simone G, De Nunzio C. Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique. Diagnostics (Basel) 2024; 14:1579. [PMID: 39125455 PMCID: PMC11311424 DOI: 10.3390/diagnostics14151579] [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: 06/02/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Sara Riolo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgia Tema
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alessio Guidotti
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Simone D’Annunzio
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Costantino Leonardo
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Cicione
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Rocco Simone Flammia
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Nacchia
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alberto Trucchi
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgio Franco
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
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Daou S, Albeaini S, Mjaess G, Diamand R, Albisinni S, Roumeguère T, Aoun F. Renorrhaphy techniques in minimally invasive partial nephrectomy: a systematic review of the literature. Minerva Urol Nephrol 2023; 75:683-695. [PMID: 38126283 DOI: 10.23736/s2724-6051.23.05345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In the absence of consensus on the optimal approach to renorrhaphy in partial nephrectomy, this systematic review aims to assess the various renorrhaphy techniques and their impact on surgical outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed in March 2022, using PubMed and Scopus, without time restrictions and research filters for studies investigating renorrhaphy techniques in partial nephrectomy. Studies providing sufficient details on renorrhaphy techniques and their outcomes during minimally invasive partial nephrectomy (PN) were included in this analysis. EVIDENCE SYNTHESIS Thirty-one studies with 5720 patients were included in the analysis. In most studies, tumor diameter was <4 cm. RENAL and PADUA scores as well as tumor locations were heterogeneous between the studies. The results of the use of hemostatic agents were conflicting among different studies with limited evidence regarding the benefits of its routine use in partial nephrectomy. The use of barbed and running sutures was associated with a reduced warm ischemia time. While some studies showed a decreased warm ischemia time when omitting cortical renorrhaphy, others found that it may lead to higher incidence of minor complications without any significant improvement in other outcomes. CONCLUSIONS There is ongoing research to determine the optimal approach to renorrhaphy. The current evidence on the routine use of hemostatic agents is limited. The use of certain techniques such as barbed sutures, sliding clips and running sutures reduced the warm ischemia time. The omission of cortical renorrhaphy is still controversial.
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Affiliation(s)
- Samah Daou
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon -
| | - Sylvana Albeaini
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Simone Albisinni
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, Rome, Italy
| | - Thierry Roumeguère
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Fouad Aoun
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
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Is hemostatic agent effective and safe in minimally invasive partial nephrectomy? Chin Med J (Engl) 2022; 135:2116-2118. [PMID: 35442229 PMCID: PMC9746783 DOI: 10.1097/cm9.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Guo Q, Lin Y, Zhang C, Guo Y, Long Y, Leng F, Gao J, Cheng Y, Yang L, Du L, Liao G, Huang J. Hemostatic Agent May Improve Perioperative Outcomes in Partial Nephrectomy: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:352-359. [PMID: 34350887 DOI: 10.1159/000518125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hemostatic agents (HAs) are used to achieve hemostasis and prevent postoperative complications in multiple surgeries, but the role of HAs is ambiguous during partial nephrectomy (PN), so this study aimed to assess the role of HAs in PN. METHODS PubMed, Embase, CENTRAL and ClinicalTrials.gov were searched for randomized controlled trials and cohort studies regarding the comparison of HA use alone and standard suturing during PN on January 17, 2020. RevMan 5.3 was used to conduct meta-analysis. Sensitivity analyses and subgroup analyses were performed based on surgical procedures and HA types. RESULTS Six studies involving 1,066 patients were included. The quality of studies was moderate to high. There were significant reductions in warm ischemia time (mean difference [MD] = -6.30 min, 95% confidence interval [CI] -7.70 to -4.90, p < 0.00001), operative time (MD = -19.81 min, 95% CI -27.54 to -12.08, p < 0.00001), and estimated blood loss (MD = -108.62 mL, 95% CI -177.27 to -39.9, p = 0.002) in the HA group, and HA use alone did not increase postoperative complications. The results were similar in the subgroup analyses and sensitivity analyses. CONCLUSION HA may be an effective and safe surgical material in PN, which can improve postoperative outcomes. High-quality and randomly designed studies are needed to validate the applicability.
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Affiliation(s)
- Qiong Guo
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China, .,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,
| | - Yifei Lin
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Chenyang Zhang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yi Guo
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Youlin Long
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fangqun Leng
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Juan Gao
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yifan Cheng
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Yang
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ga Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China.,Department of Information Management, Department of Stomatology Informatics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jin Huang
- Medical Device Regulatory Research and Evaluation Center, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Francavilla S, Abern MR, Dobbs RW, Vigneswaran HT, Talamini S, Antonelli A, Simeone C, Crivellaro S. Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1). Minerva Urol Nephrol 2021; 74:216-224. [PMID: 33769009 DOI: 10.23736/s2724-6051.21.03919-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the safety and feasibility of robotic-assisted laparoscopic partial nephrectomy (RAPN) performed using the da Vinci Single-Port (SP) platform. METHODS A retrospective review was conducted from December 2018 to December 2019 of 14 consecutive patients with localized renal cancer who underwent SP robot-assisted partial nephrectomy at a single institution. The procedures were performed by 2 experienced robotic surgeons, reproducing the steps of the standard multiport robotic approach to partial nephrectomy. A transperitoneal approach was utilized with a 2.5 cm para-rectus incision with one assistant 12 mm laparoscopic port. RESULTS No conversions to open or laparoscopic surgery occurred and no additional laparoscopic assistant ports were required. The median total operative time was 202 (162-231) minutes and the median total room time was 258 (215-295) minutes. The warm ischemia time averaged 20 minutes ± 8 minutes. 2 patients required angioembolization due to postoperative acute bleeding (Clavien-Dindo Grade 3a complication). Trifecta outcome (<25 min warm ischemia, no perioperative complications and negative margins) was achieved in 79% of patients. In one case, a positive margin was present. The median length of stay was of 1 day (Interquartile Range 1-2) with a median pain score on postoperative day 1 of 3.5 (Interquartile Range 2.4-5). 1/14 (7%) patient needed narcotic use at one week from discharge. At a median follow up of 5.0 (4.0-8.0) months, no patients have had evidence of disease recurrence. CONCLUSIONS In this initial cohort, considering the introduction of a new technology, we observed satisfactory outcomes for several key perioperative variables including operative time, warm ischemia time, surgical margins, hospital stay, pain requirements in patients undergoing RAPN with the SP platform. For experienced robotic surgeons, RAPN with the SP platform is a safe and feasible approach for single site partial nephrectomy.
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Affiliation(s)
- Simone Francavilla
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA - .,Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy - .,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy -
| | - Michael R Abern
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan W Dobbs
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hari T Vigneswaran
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Talamini
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | | | - Simone Crivellaro
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy. Surg Endosc 2021; 36:663-669. [PMID: 33591449 PMCID: PMC8741715 DOI: 10.1007/s00464-021-08333-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN. METHODS Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the "trifecta" criteria (negative surgical margin, WIT < 25 min, no complications within 30 days). RESULTS No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to "trifecta" was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively. CONCLUSION The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.
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Ye F, Li J, Wang T, Lan K, Li H, Yin H, Guo T, Zhang X, Yang T, Liang J, Wu X, Li Q, Sheng W. Efficacy and Safety of Antiplatelet Agents for Adult Patients With Ischemic Moyamoya Disease. Front Neurol 2021; 11:608000. [PMID: 33519687 PMCID: PMC7844095 DOI: 10.3389/fneur.2020.608000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The use of antiplatelet agents in ischemic moyamoya disease (MMD) is controversial. This study aimed to investigate the effectiveness and safety of antiplatelet therapy compared with conservative treatment and surgical revascularization in ischemic MMD patients. Methods: Ischemic MMD patients were retrospectively enrolled from eight clinical sites from January 2013 to December 2018. Follow-up was performed through clinical visits and/or telephone interviews from first discharge to December 2019. The primary outcome was the episodes of further ischemic attacks, and the secondary outcome was the individual functional status. Risk factors for future stroke were identified by the LASSO-Cox regression model. Propensity score matching was applied to assemble a cohort of patients with similar baseline characteristics using the TriMatch package. Results: Among 217 eligible patients, 159 patients were included in the analyses after a 1:1:1 propensity score matching. At a mean follow-up of 33 months, 12 patients (7.5%) developed further incident cerebral ischemic events (surgical:antiplatelet:conservative = 1:3:8; p = 0.030), 26 patients (16.4%) developed a poor functional status (surgical:antiplatelet:conservative = 7:12:7; p = 0.317), and 3 patients (1.8%) died of cerebral hemorrhage (surgical:antiplatelet:conservative = 1:2:0; p = 0.361). The survival curve showed that the risk of further cerebral ischemic attacks was lowest with surgical revascularization, while antiplatelet therapy was statistically significant for preventing recurrent risks compared with conservative treatment (χ2 = 8.987; p = 0.011). No significant difference was found in the functional status and bleeding events. The LASSO-Cox regression model revealed that a family history of MMD (HR = 6.93; 95% CI: 1.28-37.52; p = 0.025), a past history of stroke or transient ischemic attack (HR = 4.35; 95% CI: 1.09-17.33; p = 0.037), and treatment (HR = 0.05; 95% CI: 0.01-0.32; p = 0.001) were significantly related to the risk of recurrent strokes. Conclusions: Antiplatelet agents were effective and safe in preventing further cerebral ischemic attacks in adult patients with ischemic MMD. They may be a replacement therapy for patients with surgical contraindications and for patients prior to revascularization.
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Affiliation(s)
- Fei Ye
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianzhu Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Lan
- Department of Anesthesiology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Anesthesiology, Troops 32268 Hospital, Dali, China
| | - Haiyan Li
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haoyuan Yin
- Department of Neurosurgery, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Tongli Guo
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiong Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Yang
- Department of Neurology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Liang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenli Sheng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Cheung DC, Wallis CJD, Possee S, Tajzler C, Anidjar M, Barrett K, Deklaj T, Drachenberg DE, Evans H, French C, Gotto G, Izard J, Jain U, Kawakami J, Kulkarni GS, Lee J, McCracken J, McGregor T, Richard PO, Rowe NE, Sabbagh R, St Martin B, Tatzel S, Touma N, Widmer H, Wiesenthal J, Yang B, Zorn KC, Kapoor A, Finelli A, Satkunasivam R. Canadian Update on Surgical Procedures (CUSP) Urology Group consensus for intraoperative hemostasis during minimally invasive partial nephrectomy. Can Urol Assoc J 2020; 14:E387-E393. [PMID: 32569571 DOI: 10.5489/cuaj.6579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes. METHODS A three-step modified Delphi method was used to achieve expert agreement on the best practices for hemostasis in MIPN. Panelists were recruited from the Canadian Update on Surgical Procedures (CUSP) Urology Group, which represent all provinces, academic and community practices, and fellowship-and non-fellowship-trained surgeons. Thirty-two (round 1) and 46 (round 2) panellists participated in survey questionnaires, and 22 attended the in-person consensus meeting. RESULTS An initial literature search of 945 articles (230 abstracts) underwent screening and yielded 24 preliminary techniques. Through sequential survey assessment and in-person discussion, a total of 11 strategies were approved. These are temporally distributed prior to tumor resection (five principles), during tumor resection (two principles), and during renorrhaphy (four principles). CONCLUSIONS Given the variability in tumor size, depth, location, and vascularity, coupled with limitations of laparoscopic equipment, achieving consistent hemostasis in MIPN may be challenging. Despite over two decades of MIPN experience, limited evidence exists to guide clinicians. Through a three-step Delphi method and rigorous iterative review with a panel of experts, we ascertained a guiding checklist of principles for newly beginning and practicing urologists to reference.
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Affiliation(s)
- Douglas C Cheung
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Simon Possee
- Division of Medicine, The Rotherham Foundation Trust, South Yorkshire, United Kingdom
| | - Camilla Tajzler
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Maurice Anidjar
- Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Tom Deklaj
- Department of Surgery (Urology), Western University (Windsor Regional Hospital), London, ON, Canada
| | | | - Howard Evans
- Division of Urology, Department of Surgery, University of Alberta, AB, Canada
| | - Christopher French
- Discipline of Surgery (Urology), Memorial University, St. John's, NL, Canada
| | - Geoffrey Gotto
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jason Izard
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Umesh Jain
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jun Kawakami
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jason Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Thomas McGregor
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Neal E Rowe
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Robert Sabbagh
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Blair St Martin
- Division of Urology, Department of Surgery, University of Alberta, AB, Canada
| | - Stephanie Tatzel
- Division of Urology, Department of Surgery, McMaster University (Niagara Health), Hamilton, ON, Canada
| | - Naji Touma
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Hugues Widmer
- Section of Urology, Department of Surgery, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
| | | | - Brian Yang
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Centre (CHUM), Montreal, QC, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Raj Satkunasivam
- Center for Outcomes Research, Houston Methodist Hospital, Medical Center, Houston, TX, United States
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Hemostatic agent use during partial nephrectomy: trends, outcomes, and associated costs. Int Urol Nephrol 2020; 52:2073-2078. [PMID: 32557376 DOI: 10.1007/s11255-020-02538-3] [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: 04/06/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the ability of hemostatic agents (HA) to limit bleeding complications following partial nephrectomy (PN) and determine HA usage and costs as well as factors associated with post-operative bleeding complications. METHODS The records of 429 PN performed for kidney cancers were reviewed for clinical, pathologic, and perioperative variables. Surgical approach, HA use, and HA expenditure were determined. Bleeding complications and management to 90 days after PN were annotated. Wilcoxon rank-sum and two-sample t tests identified factors associated with HA use. Univariate and limited multivariate logistic regression determined variables associated with bleeding complications. RESULTS Use of HA was associated with longer OR duration, longer ischemia time, higher EBL, and method of PN (OPN and LPN > RPN) (all p values < 0.001). On bivariate analysis, while multiple factors were associated with bleeding complications, neither HA use (p = 0.924) nor the number of HA used (two agents vs one p = 0.712; three agents vs. one p = 0.606) were. A multivariable model noted that increasing RENAL score (p = 0.013) and surgical approach (OPN vs. RPN [p = 0.009] and LPN vs. RPN (p = 0.002]) were independently associated with bleeding complications, while HA use was not (p = 0.294). During the 16 years of analysis, a total of $77,687 USD was spent on HA. Average annual HA expenditure was $4855 USD with the peak being in 2010 where expense was $14,086. Mean annual costs for HA use were greater for OPN vs RAPN starting in 2013 (p = 0.02) CONCLUSIONS: The use of HA during PN was not associated with lower rates of bleeding complications. Therefore, judicious use in a case-specific manner is requisite to limit potentially unnecessary operative cost.
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10
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Pacheco M, Barros AA, Aroso IM, Autorino R, Lima E, Silva JM, Reis RL. Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective. J Biomed Mater Res B Appl Biomater 2020; 108:3099-3123. [PMID: 32458570 DOI: 10.1002/jbm.b.34637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.
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Affiliation(s)
- Margarida Pacheco
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre A Barros
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ivo M Aroso
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Estêvão Lima
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Joana M Silva
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Aykan S, Temiz MZ, Ulus I, Yilmaz M, Gonultas S, Suzan S, Semercioz A, Muslumanoglu AY. The Use of Three Different Hemostatic Agents during Laparoscopic Partial Nephrectomy: A Comparison of Surgical and Early Renal Functional Outcomes. Eurasian J Med 2019; 51:160-164. [PMID: 31258357 PMCID: PMC6592448 DOI: 10.5152/eurasianjmed.2018.18293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to compare the effects of three different hemostatic agents on surgical and early renal functional outcomes after laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS A total of 126 cases of LPN performed between November 2008 and September 2016 were enrolled in this study. Spongostan™ Absorbable Hemostatic Gelatin Sponge (Ethicon, Somerville, NJ, USA) or Surgicel® Original Absorbable Hemostat (Ethicon, Somerville, NJ, USA), or a total of 5 mL of Floseal® Hemostatic Matrix (Baxter Healthcare, Deerfield, IL) was used for additional hemostasis. According to the hemostatic agent used, patients were divided into three groups; and patient characteristics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor characteristics, perioperative parameters, serum creatinine levels, and complications were compared among these three groups. RESULTS Age, BMI, ASA score, tumor characteristics, operative time, warm ischemia time, complication rates, and length of hospital stay were similar among the groups, whereas estimated blood loss was significantly lower in the Floseal Group (p=0.01). Postoperative serum creatinine levels and differences between preoperative and postoperative serum creatinine levels were also similar among the groups. CONCLUSION The type of hemostatic agent used in LPN may affect the estimated blood loss. However, it has no substantial effect on other surgical parameters and early renal functional outcomes.
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Affiliation(s)
- Serdar Aykan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | - Ismail Ulus
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yilmaz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Serkan Gonultas
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Serhat Suzan
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Garisto J, Bertolo R, Agudelo J, Armanyous S, Gao T, Lioudis M, Kaouk JH. Cold ischemia technique during robotic partial nephrectomy: a propensity score-matched comparison with open approach. MINERVA UROL NEFROL 2019; 71:127-135. [DOI: 10.23736/s0393-2249.18.03276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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13
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Kisa E, Sahin H, Cakmak O, Yucel C, Koc G, Kozacioglu Z, Ilbey YO. Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy. Int Urol Nephrol 2019; 51:917-925. [PMID: 30955139 DOI: 10.1007/s11255-019-02141-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/02/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the characteristics of images generated by magnetic resonance imaging (MRI) and changes in the mass-like lesion (MLL) during the follow-up of patients who underwent partial nephrectomy (PN) with the intra-operative use of hemostatic agents (HAs). METHODS The records of patients who had undergone PN in our clinic due to renal mass between January 2013 and August 2018 were retrospectively reviewed. Our study included 47 patients who were administered one or more HAs during the PN and who received diffusion and dynamic MRI at the post-operative 2nd/4th Queryand 12th month. RESULTS MLL is defined as T2 heterogeneous, intermediate-signal intensity bolster-related mass with a pseudocapsule in the renal parenchymal defect. When we looked at the morphological changes of MLL, the mean largest axial dimensions of masses were 27.3 (range 12.2-44.7) mm in the first follow-up period (2nd/4th months) and 21.2 (range 11-44.7) mm in the 12th month follow-up period. The average change in size of MLL was - 0.66 mm/month. We did not see any significant relationship between observation of MLL in the post-operative follow-up MRI images and the use of HAs such as Surgicel®, Spongostan®, and autologous fatty tissue as well as the amount of the agents used in PN operations (p = 0.405, p = 0.159, respectively). CONCLUSIONS The distinction of MLL causing bolster-related mass and granulomatosis tissue from relapse/recurrence can be made based on the change in mass size observed in the MR images and image characteristics.
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Affiliation(s)
- Erdem Kisa
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey.
| | - Hilal Sahin
- Department of Radiology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Ozgür Cakmak
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Cem Yucel
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Gokhan Koc
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Zafer Kozacioglu
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
| | - Yusuf Ozlem Ilbey
- Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey
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Bertolo R, Garisto J, Dagenais J, Sagalovich D, Stein R, Fareed K, Gao T, Armanyous S, Fergany A, Lioudis M, Kaouk J. Transperitoneal Robot-assisted Partial Nephrectomy with Minimum Follow-up of 5 Years: Oncological and Functional Outcomes from a Single Institution. Eur Urol Oncol 2019; 2:207-213. [DOI: 10.1016/j.euo.2018.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/12/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
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Ischemia Techniques in Nephron-sparing Surgery: A Systematic Review and Meta-Analysis of Surgical, Oncological, and Functional Outcomes. Eur Urol 2018; 75:477-491. [PMID: 30327272 DOI: 10.1016/j.eururo.2018.10.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/01/2018] [Indexed: 01/20/2023]
Abstract
CONTEXT The optimal ischemia technique at partial nephrectomy (PN) for renal masses is yet to be determined. OBJECTIVE To summarize and analyze the current evidence about surgical, oncological, and functional outcomes after different ischemia techniques (cold, warm, and zero ischemia) at PN. EVIDENCE ACQUISITION A computerized systematic literature search was performed by using PubMed (MEDLINE) and Science Direct. Identification and selection of the studies were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Outcomes of interest were estimated blood loss (EBL), overall complications, positive surgical margins, local tumor recurrence, and renal function preservation. Meta-analysis and forest-plot diagrams were performed. Overall pooled estimates, together with 95% confidence intervals (CIs), of the incidence of all parameters were obtained using a random effect model (RE-Model) on the log transformed means (MLN), proportion, or standardized mean change, as deemed appropriate. EVIDENCE SYNTHESIS One hundred and fifty-six studies were included. No clinically meaningful differences were found in terms of EBL after cold (mean: 215.5; 95% CI: 154.2-276.8m), warm (mean: 201.8; 95% CI: 175.0-228.7ml), or zero (mean: 261.2; 95% CI: 171.0-351.3ml) ischemia technique. Overall, postoperative complications were recorded in 14.1% (95% CI: 6.7-27.4), 11.1% (95% CI: 10.0-12.3), and 9.7% (95% CI: 7.7-12.2) of patients after cold, warm, and zero ischemia (p<0.01), respectively. Positive surgical margins were recorded in 4.8% (95% CI: 1.9-10.9), 4.0% (95% CI: 3.4-4.8), and 5.6% (95% CI: 3.1-9.8) of patients after cold, warm, and zero ischemia (p<0.01), respectively. Local recurrence was recorded in 3.2% (95% CI: 1.9-5.2) and 3.1% (95% CI: 0.7-11.5) of patients after warm and zero ischemia (p<0.01), respectively. The log2 of estimated glomerular filtration ratio mean changes were-1.37 (95% CI:-3.42 to 0.68),-1.00 (-2.04 to 0.03), and-0.71 (-1.15 to-0.27) ml/min after cold, warm, and zero ischemia, respectively. Low level of evidence, retrospective nature of most of included studies, a high risk of selection bias, and heterogeneity within included studies limited the overall quality of the analysis. CONCLUSIONS The effect of ischemia technique at PN is still debatable and subject to confounding by several factors, namely, patients' selection criteria, surgical technique used, and percentage of functional parenchyma spared during surgery. These confounders bias available evidence and were addressed by only a small part of available studies. Unfortunately, the overall quality of literature evidences and the high risk of selection bias limit the possibility of any causal interpretation about the relationship between the ischemia technique used and surgical, oncological, or functional outcomes. Thus, none of the available ischemia technique could be recommended over the other. PATIENT SUMMARY The present analysis shows that none of the available ischemia techniques, namely, cold, warm, or zero ischemia, is universally superior to the others, and other factors play a role in the surgical outcome.
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Thoracoscopic Treatment of Pneumothorax in Marfan Syndrome: Hemostatic Patch to Support Lung Resection Recovery. Case Rep Surg 2018; 2018:7597215. [PMID: 30254783 PMCID: PMC6142756 DOI: 10.1155/2018/7597215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/31/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction In selected patients, the absorbable fibrin patch TachoSil® is superior to standard surgical treatment in reducing air leakage after pulmonary lobectomy. Pulmonary involvement is not considered a main feature of Marfan syndrome (MFS); however, spontaneous pneumothorax (SP) with a high rate of recurrence is frequently reported. We describe the use of TachoSil® in the supportive treatment of recurrent pneumothorax in a girl with MFS. Case Report A 12-year-old girl with a previous diagnosis of MFS and recurrent history of left spontaneous pneumothorax was submitted to thoracoscopic atypical lung resection. Two patches (9.5 × 4.8 cm) were cut from the adhesive/foam complex (TachoSil®) and were pressed against the sutured area as supportive treatment. The patient recovered with no further SP recurrences. Conclusions The use of the TachoSil® surgical patch may be useful in pneumothorax supportive treatment, particularly in pediatric MFS by ameliorating the mechanical strength of the lung.
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Pradere B, Peyronnet B, Khene ZE, Mathieu R, Verhoest G, Bensalah K. Simplified robot-assisted partial nephrectomy: step-by-step technique and perioperative outcomes. J Robot Surg 2018; 13:245-251. [PMID: 29982905 DOI: 10.1007/s11701-018-0845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022]
Abstract
Controversies have been raised and still exist regarding several technical aspects of robot-assisted partial nephrectomy (RAPN). While the "perfect RAPN" has still to be determined, we aimed to report a simplified technique of RAPN in a step-by-step fashion and the perioperative outcomes of a single-center series. A simplified technique of RAPN was developed, refined and standardized over the past 7 years in an academic department of urology to make it as safe and as reproducible as possible, the main goal being to make it an "easy to learn" technique for fellows. This technique is presented in 12 key steps. The patients' characteristics and perioperative outcomes were prospectively collected and are reported herein. Since the first case performed in our department in 2010, 406 patients have undergone RAPN with a standardized and stable simplified technique after the first 30 cases, involving several key steps including systematic use of the transperitoneal approach, minimal visceral mobilization of the colon, systematic psoas exposure and ureter identification, minimal dissection of the perinephric fat, arterial clamping with early unclamping, no use of hemostatic agents or drain. The majority of RAPN were performed by surgeons with either low experience (i.e., < 20 procedures; 46.3%) or intermediate experience (i.e., 20-50 procedures; 17.2%). The mean warm ischemia time was 15.3 min. Conversions to an open approach and to radical nephrectomy were required in 14 (3.5%) and 21 (5.2%) cases, respectively. From 132 patients who experienced post-operative complications (32.5%), 47 experienced a major complication (11.6%). The positive surgical margin rate was 5.6%. The simplified technique of RAPN was feasible and reproducible with satisfactory perioperative outcomes. Most of the key steps have been assessed through single-center and multicenter clinical studies.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Benoit Peyronnet
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Zine-Eddine Khene
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Gregory Verhoest
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Karim Bensalah
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
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Carrion DM, Y Gregorio SA, Rivas JG, Bazán AA, Sebastián JD, Martínez-Piñeiro L. The role of hemostatic agents in preventing complications in laparoscopic partial nephrectomy. Cent European J Urol 2018; 70:362-367. [PMID: 29410886 PMCID: PMC5791400 DOI: 10.5173/ceju.2017.1432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Nephron-sparing surgery is currently the treatment of choice for renal cell carcinoma stage T1a. During the past years, several hemostatic agents (HA) have been developed in order to reduce surgical complications. We present the results of our series and the impact of the use of HA in the prevention of surgical complications in laparoscopic partial nephrectomies (LPNs). Material and methods We retrospectively analyzed all LPN performed in our center from 2005 to 2012. A total of 77 patients were included for analysis. Patients were divided into two groups: Group A (no use of HA) and Group B (use of HA). HA used included gelatin matrix thrombin (FloSeal) and oxidized regenerated cellulose (Surgicel). Demographics, perioperative variables, and complications were analyzed with a special interest in postoperative bleeding and urinary leakage. Results Median age was 57.17 years old (±12.1), 72.7% were male, most common comorbidities were hypertension (33.8%) and diabetes mellitus (18.2%). All patients had one solitary tumor, and 87% had a tumor ≤4 cm. Renal cell carcinoma was found in 79.2% of cases, and 78.7% were stage pT1a. and were used in 36 cases (46.8%). No differences were found in demographics, perioperative variables, and complications between groups. No conversions to open surgery or perioperative mortality were reported. Conclusions We conclude that in our series the use of a hemostatic agent did not offer benefit in reducing the complication rate over sutures over a bolster.
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Affiliation(s)
- Diego M Carrion
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Gazzeri R, Galarza M, Morabito M, Alfieri A. Clinical Use and Hemostatic Application of Gelatin. POLYMER GELS 2018. [DOI: 10.1007/978-981-10-6083-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project). Eur J Surg Oncol 2017; 43:823-830. [DOI: 10.1016/j.ejso.2016.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/30/2016] [Accepted: 10/14/2016] [Indexed: 11/22/2022] Open
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Masago T, Yamaguchi N, Iwamoto H, Morizane S, Hikita K, Honda M, Sejima T, Takenaka A. The significance of predictable traumatic area by renorrhaphy in the prediction of postoperative ipsilateral renal function. Cent European J Urol 2017; 71:64-71. [PMID: 29732209 PMCID: PMC5926639 DOI: 10.5173/ceju.2018.1557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 09/29/2017] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction To determine the relationship between the actual renal function loss and volume loss in robot-assisted partial nephrectomy (RAPN) using a novel three-dimensional volume analyzer. Material and methods We respectively evaluated the medical records of 23 consecutive patients who underwent RAPN between January 2012 and March 2016 and the data on their kidney function and parenchymal mass specific to the operated kidney. Parenchymal volume was measured by computerized tomography and reconstructed with a Synapse Vincent volumetric analyzer. Using this system, we predicted the renal vascular territory and other trauma areas involved in renorrhaphy. All measurements were taken within 3 and 6 months pre- and postoperatively, respectively. RESULTS The actual postoperative renal parenchymal volume was significantly correlated with the virtual predicted residual renal volume excluding the tumor and resected margin (r = 0.435, p <0.05). The ratio of split estimated glomerular filtration rate (eGFR) postoperative/preoperative) was significantly correlated with the virtual predicted residual renal volume excluding the resected margin and the traumatic area by renorrhaphy (r = 0.401, p <0.05). Conclusions When predicting the reduction of renal function of the diseased side following partial nephrectomy, adding the extent of the area traumatized by renorrhaphy might be useful for predicting the postoperative split renal function of the affected kidney.
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Affiliation(s)
- Toshihiko Masago
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan.,Division of Urology, Department of Surgery, National Hospital Organization, Yonago Medical Center, Tottori, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Katsuya Hikita
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | | | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
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Rassweiler JJ, Klein J, Tschada A, Gözen AS. Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: demonstration of technique and matched-pair analysis. BJU Int 2016; 119:349-357. [DOI: 10.1111/bju.13627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jan Klein
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Alexandra Tschada
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Ali Serdar Gözen
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
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Packiam VT, Nottingham CU, Cohen AJ, Pearce SM, Shalhav AL, Eggener SE. The Impact of Perioperative Aspirin on Bleeding Complications Following Robotic Partial Nephrectomy. J Endourol 2016; 30:997-1003. [DOI: 10.1089/end.2016.0290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Andrew J. Cohen
- Section of Urology, University of Chicago, Chicago, Illinois
| | - Shane M. Pearce
- Section of Urology, University of Chicago, Chicago, Illinois
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Maurice MJ, Ramirez D, Kara Ö, Malkoç E, Nelson RJ, Caputo PA, Kaouk JH. Omission of Hemostatic Agents During Robotic Partial Nephrectomy Does Not Increase Postoperative Bleeding Risk. J Endourol 2016; 30:877-83. [PMID: 27279548 DOI: 10.1089/end.2016.0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Matthew J. Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Ramirez
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Önder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ercan Malkoç
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J. Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter A. Caputo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication. BIOMED RESEARCH INTERNATIONAL 2015; 2015:981251. [PMID: 26539549 PMCID: PMC4619914 DOI: 10.1155/2015/981251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment.
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