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Patel J, Jones CN. Anaesthesia for Major Urological Surgery. Anesthesiol Clin 2022; 40:175-197. [PMID: 35236579 DOI: 10.1016/j.anclin.2021.11.009] [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: 06/14/2023]
Abstract
This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to explore the anesthetic considerations for both open and minimally invasive techniques.
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Affiliation(s)
- Jaishel Patel
- Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - Christopher N Jones
- Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
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Minervini A, Mari A, Borghesi M, Antonelli A, Bertolo R, Bianchi G, Brunocilla E, Ficarra V, Fiori C, Longo N, Mirone V, Morgia G, Porpiglia F, Rocco B, Serni S, Simeone C, Tellini R, Volpe A, Carini M, Schiavina R. The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project. MINERVA UROL NEFROL 2019; 71:47-54. [DOI: 10.23736/s0393-2249.18.03202-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tsai SH, Tseng PT, Sherer BA, Lai YC, Lin PY, Wu CK, Stoller ML. Open versus robotic partial nephrectomy: Systematic review and meta-analysis of contemporary studies. Int J Med Robot 2018; 15:e1963. [PMID: 30265760 DOI: 10.1002/rcs.1963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To compare perioperative outcomes of robotic-assisted partial nephrectomy (RaPN) with open partial nephrectomy (OPN). METHODS Systematically search through PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov for eligible studies was performed to April 11, 2018. A meta-analysis was conducted for studies comparing RaPN and OPN. Confounding variables were assessed by meta-regression or subgroup analysis. RESULTS This study included 34 studies with 60 808 patients. Meta-analysis revealed less blood loss, less transfusion, longer operative time, less postoperative complications, lower readmission rate, shorter length of stay, and less estimated glomerular filtration rate (eGFR) decline in RaPN groups. The superiority of RaPN in blood loss was attenuated with highly complex renal masses. The superiority of RaPN in intraoperative complications was strengthened with renal hilar control. The advantage of RaPN in surgical margin was increased in patient with body mass index (BMI) < 28. CONCLUSIONS Compared with OPN, RaPN provided lower morbidities and better renal function preservation.
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Affiliation(s)
- Sheng-Han Tsai
- Department of Urology, Cheng Hsin General Hospital, Taipei City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Tao Tseng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan.,WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
| | - Benjamin A Sherer
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Yi-Chen Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Veteran General Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Kuan Wu
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California
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Affiliation(s)
- Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Porpiglia
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
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Porpiglia F, Mari A, Bertolo R, Antonelli A, Bianchi G, Fidanza F, Fiori C, Furlan M, Morgia G, Novara G, Rocco B, Rovereto B, Serni S, Simeone C, Carini M, Minervini A. Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project). Urology 2015; 89:45-51. [PMID: 26743388 DOI: 10.1016/j.urology.2015.08.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Accepted: 08/28/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset. METHODS Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. RESULTS The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. CONCLUSION Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
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Affiliation(s)
- Francesco Porpiglia
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | | | - Giampaolo Bianchi
- Policlinico di Modena, Department of Urology, University of Modena, Italy
| | - Francesco Fidanza
- Policlinico di Modena, Department of Urology, University of Modena, Italy
| | - Cristian Fiori
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Maria Furlan
- Department of Urology, Azienda AO Spedali Civili di Brescia, Italy
| | | | | | - Bernardo Rocco
- Department of Urology, University of Padua, I.R.C.C.S. Foundation Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Rovereto
- I.R.C.C.S. Policlinico San Matteo-Department of Urology, Pavia, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Claudio Simeone
- Department of Urology, Azienda AO Spedali Civili di Brescia, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
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Patton MW, Salevitz DA, Tyson MD, Andrews PE, Ferrigni EN, Nateras RN, Castle EP. Robot-assisted partial nephrectomy for complex renal masses. J Robot Surg 2015; 10:27-31. [DOI: 10.1007/s11701-015-0554-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/27/2015] [Indexed: 01/20/2023]
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A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project). Eur J Surg Oncol 2015; 41:346-52. [DOI: 10.1016/j.ejso.2014.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/11/2014] [Indexed: 01/17/2023] Open
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Reddy UD, Pillai R, Parker RA, Weston J, Burgess NA, Ho ETS, Mills RD, Rochester MA. Prediction of complications after partial nephrectomy by RENAL nephrometry score. Ann R Coll Surg Engl 2014; 96:475-9. [PMID: 25198982 DOI: 10.1308/003588414x13946184903522] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Discussing and planning the appropriate management for suspicious renal masses can be challenging. With the development of nephrometry scoring methods, we aimed to evaluate the ability of the RENAL nephrometry score to predict both the incidence of postoperative complications and the change in renal function after a partial nephrectomy. METHODS This was a retrospective study including 128 consecutive patients who underwent a partial nephrectomy (open and laparoscopic) for renal lesions in a tertiary UK referral centre. Univariate and multivariate ordinal regression models were used to identify associations between Clavien-Dindo classification and explanatory variables. The Kendall rank correlation coefficient was used to examine an association between RENAL nephrometry score and a drop in estimated glomerular filtration rate (eGFR) following surgery. RESULTS An increase in the RENAL nephrometry score of one point resulted in greater odds of being in a higher Clavien-Dindo classification after controlling for RENAL suffix and type of surgical procedure (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.04-1.64, p=0.043). Furthermore, a patient with the RENAL suffix 'p' (ie posterior location of tumour) had increased odds of developing more serious complications (OR: 2.60, 95% CI: 1.07-6.30, p=0.042). A correlation was shown between RENAL nephrometry score and postoperative drop in eGFR (Kendall's tau coefficient -0.24, p=0.004). CONCLUSIONS To our knowledge, this is the first study that has shown the predictive ability of the RENAL nephrometry scoring system in a UK cohort both in terms of postoperative complications and change in renal function.
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Affiliation(s)
- U D Reddy
- Norfolk and Norwich University Hospitals NHS Foundation Trust, UK
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Monn MF, Bahler CD, Flack CK, Dube HT, Sundaram CP. The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial Nephrectomy. J Endourol 2014; 28:1231-6. [DOI: 10.1089/end.2014.0265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Clinton D. Bahler
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Chandra K. Flack
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Hitesh T. Dube
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine Indianapolis, Indiana
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Minervini A, Siena G, Carini M. Hemostatics for nephron-sparing surgery. Expert Rev Med Devices 2014; 10:153-5. [DOI: 10.1586/erd.12.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Minervini A, Siena G, Serni S, Carini M. Robotic laparoscopic single-site partial nephrectomy: almost like driving with the steering lock engaged. Eur Urol 2013; 66:518-9; discussion 520-1. [PMID: 24398048 DOI: 10.1016/j.eururo.2013.11.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/29/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
| | - Giampaolo Siena
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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Bi L, Zhang C, Li K, Fan X, Xu K, Han J, Huang H, Liu H, Dong W, Yang X, Huang J, Lin T. Robotic partial nephrectomy for renal tumors larger than 4 cm: a systematic review and meta-analysis. PLoS One 2013; 8:e75050. [PMID: 24116024 PMCID: PMC3792962 DOI: 10.1371/journal.pone.0075050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/02/2013] [Indexed: 01/31/2023] Open
Abstract
Background With the establishment of minimally invasive surgery in society, the robot has been increasingly widely used in the urologic field, including in partial nephrectomy. This study aimed to comprehensively summarize the currently available evidence on the feasibility and safety of robotic partial nephrectomy for renal tumors of >4 cm. Method and Findings An electronic database search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed. This systematic review and meta-analysis was based on all relevant studies that assessed robotic partial nephrectomy for renal tumors of >4 cm. Five studies were included. The meta-analysis involved 3 studies from 11 institutions including 154 patients, while the narrative review involved the remaining 2 studies from 5 institutions including 64 patients. In the meta-analysis, the mean ischemic time, operation time, and console time was 28, 319, and 189 minutes, respectively. The estimated blood loss and length of stay was 317 ml and 3.8 days, respectively. The rates of conversion, positive margins, intraoperative complications, postoperative complications, hilar clamping, and collecting system repair were 7.0%, 3.5%, 7.0%, 9.8%, 93.9%, and 47.5%, respectively. The narrative review showed results similar to those of the meta-analysis. Conclusions Robotic partial nephrectomy is feasible and safe for renal tumors of >4 cm with an acceptable warm ischemic time, positive margin rate, conversion rate, complication rate, operation time, estimated blood loss, and length of stay.
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Affiliation(s)
- Liangkuan Bi
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China ; Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China
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Froghi S, Ahmed K, Khan MS, Dasgupta P, Challacombe B. Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int 2013; 112:E322-33. [PMID: 23480733 DOI: 10.1111/bju.12053] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta-analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies. MATERIALS AND METHODS A systematic review of the literature was performed to identify studies comparing LPN and RPN. Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected. Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected. A meta-analysis using random effect model was performed. A further Bland-Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques. RESULTS Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN). There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] -12.01 to 104.26). Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI -15.22 to 3.70). Also, LOS (P = 0.22, 95% CI -0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI -0.05 to 0.06). CONCLUSIONS Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient. Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.
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Affiliation(s)
- Saied Froghi
- MRC Centre for Transplantation, King's College London, King's Health Partners, Hospital, London, UK
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