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Cannoletta D, Pellegrino AA, Pettenuzzo G, Morgantini L, Calvo RS, Torres-Anguiano JR, Mazzone E, Antonelli A, Montorsi F, Briganti A, Crivellaro S. Surgical outcomes of novel retroperitoneal low anterior vs posterior and transperitoneal access in single-port partial nephrectomy. World J Urol 2024; 42:387. [PMID: 38958744 DOI: 10.1007/s00345-024-05096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE Single-Port Robot-Assisted Partial Nephrectomy (SP-RAPN) can be performed by transperitoneal and retroperitoneal approaches. However, there is a lack of surgical outcomes for novel Retroperitoneal Low Anterior Access (LAA) in SP-RAPN. The study compared outcomes of the standard approach (SA), considering transperitoneal (TP) and posterior retroperitoneal (RP) access vs LAA in SP-RAPN series. METHODS 102 consecutive patients underwent SP-RAPN between 2019 and 2023 at a tertiary referral robotic center were identified. Baseline characteristics, peri- and post-operative outcomes were collected. Patients were stratified according to surgical approach into standard (RP or TP) vs LAA and, subsequently, RP vs LAA. Multivariable logistic regression analysis was used to test the probability of the same-day discharge adjusting for comorbidity indexes. RESULTS Overall, 102 consecutive patients were included in this study (68 SA - 26 TP and 42 posterior RP vs 34 LAA). Median age was 60 (IQR 51.5-66) years and median BMI was 31 (IQR 26.3-37.6). No baseline differences were observed. LAA exhibited significantly shorter length of stay (LOS) (median 10 [IQR 8-12] vs 24 [IQR 12-30.2.] hours, p < .0001), reduced post-operative pain (p < .0001) and decreased narcotic use on 0-1 PO Day (p < .001) compared to SA and RP only. Multivariate analysis, adjusting for comorbidities, identified LAA as a strong predictor for Same-Day Discharge. CONCLUSION LAA is an effective approach as well as RP and TP, regardless of the renal mass location, whether it is anterior or posterior, upper/mid or lower pole, yielding favorable outcomes in LOS, post-operative pain and decreased narcotics use compared to SA in SP-RAPN.
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Affiliation(s)
- Donato Cannoletta
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Antony Angelo Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Greta Pettenuzzo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ruben Sauer Calvo
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Wang Y, Butaney M, Wilder S, Ghani K, Rogers CG, Lane BR. The evolving management of small renal masses. Nat Rev Urol 2024; 21:406-421. [PMID: 38365895 DOI: 10.1038/s41585-023-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI, USA.
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
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Bertolo R, Ditonno F, Veccia A, De Marco V, Migliorini F, Porcaro AB, Rizzetto R, Cerruto MA, Autorino R, Antonelli A. Postoperative outcomes of transperitoneal versus retroperitoneal robotic partial nephrectomy: a propensity-score matched comparison focused on patient mobilization, return to bowel function, and pain. J Robot Surg 2024; 18:96. [PMID: 38413473 PMCID: PMC10899314 DOI: 10.1007/s11701-024-01860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
Literature meta-analyses comparing transperitoneal versus retroperitoneal approach to robotic partial nephrectomy (RPN) suggested some advantages favoring retroperitoneoscopy. Unfortunately, patient-centered data about mobilization, canalization, pain, and use of painkillers remained anecdotally reported. The present analysis aimed to compare transperitoneal versus retroperitoneal RPN focusing on such outcomes. Study data including baseline variables, perioperative, and postoperative outcomes of interest were retrieved from prospectively maintained institutional database (Jan 2018-May 2023) and compared between treatment groups (transperitoneal versus retroperitoneal). Propensity score matching was performed using the STATA command psmatch2 considering age, sex, body mass index, previous abdominal surgery, RENAL score, tumor size and location, and cT stage. The logit of propensity score was used for matching, with a 1:1 nearest neighbor algorithm, without replacement (caliper of 0.001). A total of 442 patients were included in the unmatched analysis: 330 underwent transperitoneal RPN 112 retroperitoneal RPN. After propensity score, 98 patients who underwent retroperitoneal RPN were matched with 98 patients who underwent transperitoneal RPN. Matched cohorts had comparable patients' demographics and tumor features. We found similarity between the two laparoscopic accesses in all outcomes but in blood loss, which favored retroperitoneoscopic RPN (median 150 (IQR 100-300) versus 100 (IQR 0-100) ml, p = 0.03). No differences were found in terms of time to mobilization with ambulation, return to complete bowel function, postoperative pain, but higher painkillers consumption was reported after transperitoneal RPN (p < 0.004). The present study compared the transperitoneal versus the retroperitoneal approach to RPN, confirming the similarity between the two approaches in all perioperative outcomes. Based on our findings, the choice of the surgical approach to RPN may remain something that the surgeon decides.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, AUOI Verona, Borgo Trento Hospital, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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Meneghetti I, Sighinolfi MC, Dibitetto F, Collins JW, Mosillo L, Catalano C, Rocco B, De Dominicis M, De Maria M. Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience. J Robot Surg 2024; 18:73. [PMID: 38349425 DOI: 10.1007/s11701-024-01843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024]
Abstract
Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.
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Affiliation(s)
| | | | - Francesco Dibitetto
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Division of Uro-oncology, University College London Hospital, London, UK
- CMR Surgical, Cambridge, UK
| | - Luca Mosillo
- Department of Urology, Apuane Hospital, Massa, Italy
| | | | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro De Dominicis
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
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