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Nguyen HN, Yamada A, Naka S, Mukaisho KI, Tani T. Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model. Front Surg 2023; 10:1255929. [PMID: 37795145 PMCID: PMC10546044 DOI: 10.3389/fsurg.2023.1255929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives To compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs. Methods We performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann-Whitney U-test. Results We successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations. Conclusions Off-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs.
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Affiliation(s)
- Ha Ngoc Nguyen
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Atsushi Yamada
- Medical Innovation Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Shigeyuki Naka
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Surgery, Hino Memorial Hospital, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Division of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Tohru Tani
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
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Wu Z, Amparore D, Campi R, Erdem S, Bertolo R. Prevention of the "cheese-cutter effect" during renorrhaphy after partial nephrectomy: by modifying available techniques or by just omitting cortical renorrhaphy? Minerva Urol Nephrol 2023; 75:410-412. [PMID: 37221832 DOI: 10.23736/s2724-6051.23.05366-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Zhenjie Wu
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Robotic-assisted partial nephrectomy: single-layer cortical renorrhaphy is associated with reduced rate of renal artery pseudoaneurysm compared to double-layer renorrhaphy. J Robot Surg 2023; 17:31-35. [PMID: 35260969 DOI: 10.1007/s11701-022-01394-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
The study compares the outcome of patients who underwent single-layer outer cortical renorraphy (SLOCR) and double-layer cortical renorraphy (DLR) in our institution. The retrospective analysis of 181 patients who underwent RAPN was performed. Propensity score matching was accomplished on 67 patients using age, BMI, size, distance from collecting system, hilar location and pathological stage. Intraoperative factors assessed included warm ischemia time, renorraphy time, blood loss and operative duration (Levey et al. in Clin Chem 53:766-772, 2007) Post-operative hospital stay, complications like renal artery pseudoaneurysm (RAP), hemorrhage, urine leak and reduction in eGFR were measured. The 67 patients in SLOCR group were compared with similar number in the DLR group using propensity score matching. Warm ischemia time (P < .001), renorraphy time (P < .001) and symptomatic pseudoaneurysm (RAP) rate (P < .001) were significantly less in SLOCR group. SLOCR is associated with reduced rate of symptomatic post-operative RAP.
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Amparore D, Pecoraro A, Piramide F, Verri P, Checcucci E, De Cillis S, Piana A, Burgio M, Di Dio M, Manfredi M, Fiori C, Porpiglia F. Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimal invasive partial nephrectomy: A pilot study. Asian J Urol 2022; 9:263-271. [PMID: 36035345 PMCID: PMC9399544 DOI: 10.1016/j.ajur.2022.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
- Corresponding author. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Paolo Verri
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology (EAU) Young Academic Urologists (YAU) Uro-technology and SoMe Working Group, Arnhem, Netherlands
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Mariano Burgio
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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Diana P, Muselaers S, Kara O, Pavan N, Pecoraro A, Carbonara U, Campi R, Amparore D. The impact of ischemic injury in patients with solitary kidneys: new cornerstones for contemporary "precision" robot-assisted partial nephrectomy. Minerva Urol Nephrol 2022; 73:851-853. [PMID: 35144369 DOI: 10.23736/s2724-6051.21.04810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain - .,Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Stijn Muselaers
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Onder Kara
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicola Pavan
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Angela Pecoraro
- Department of Urology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | | | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Daniele Amparore
- Department of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Giulioni C, Di Biase M, Marconi A, Sortino G, Diambrini M, Iacovelli V, Giannubilo W, Ferrara V. Clampless Laparoscopic Tumor Enucleation for Exophytic Masses Greater Than 4 cm: Is Renorrhaphy Necessary? J Laparoendosc Adv Surg Tech A 2022; 32:931-937. [PMID: 35443800 DOI: 10.1089/lap.2021.0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To demonstrate the safety of clampless 3D laparoscopic tumor enucleation (cLTE) for exophytic T1b kidney masses, avoiding suture to achieve hemostasis. Methods: Between January 2010 and January 2021, 241 consecutive patients with an exophytic renal tumor underwent sutureless cLTE. Patients with predominantly endophytic growth or tumors 4 mm closer to the collecting system less were excluded. In all cases, an attempt was made to accomplish surgery without suturing kidney parenchyma. Data were obtained from a retrospective review of history and physical examinations, operative and pathology reports, anesthesia records during the hospital stay, and follow-up visits. Results: Among 241 patients who underwent cLTE, 148 had cT1a and 93 had cT1b renal tumor. The median tumor size was 32 mm, and the median R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) score was 6. Renorrhaphy was necessary in 5 cases. The median operative time (OT) was 100 minutes, and the estimated blood loss (EBL) was 150 mL. The median 24-hour decrease in hemoglobin was 1.8 g/dL. The median length of stay was 4 days. Nineteen patients had postoperative complications: 3 cases had Clavien-Dindo (CD) 3a or more, 6 had CD2, and 10 had CD1. Comparing the T1a and T1b groups, except for the median OT and the EBL, no significant differences were observed in all the other variables analyzed. In both groups, renal function was preserved after 1 year from surgery. Conclusion: Our experience showed that sutureless cLTE is safe and feasible for T1b tumors leading to radical oncological outcomes and preserving renal function.
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Affiliation(s)
- Carlo Giulioni
- Department of Urology, University Hospital "Ospedali Riuniti," Ancona, Italy
| | | | - Andrea Marconi
- Department of Urology, Hospital "Carlo Urbani," Jesi, Italy
| | | | | | - Valerio Iacovelli
- Urology Unit, San Carlo di Nancy General Hospital-GVM Care and Research, Rome, Italy
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Jin Y, Xiong H, Xia Q, Zhang Q. A Modified Two-Layer Suture Technique for Transperitoneal Laparoscopic Partial Nephrectomy: Single-Center Clinical Experience. Front Surg 2022; 8:761090. [PMID: 35178424 PMCID: PMC8843823 DOI: 10.3389/fsurg.2021.761090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Purposes This study aims to evaluate the feasibility and efficacy of a modified two-layer suture method during laparoscopic partial nephrectomy (LPN) by a comparative analysis with the traditional two-layer suture. Methods A total of 60 LPN patients were enrolled in this study, of which 30 patients received the modified two-layer suture method and the remaining 30 patients underwent the traditional two-layer suture. Then, surgical characteristics including operative time, warm ischemic time (WIT), estimated blood loss (EBL), and glomerular filtration rate (GFR) were recorded. Finally, univariable and multivariable linear regression analyses were used to evaluate the correlations of tumor characteristics, suture methods, and postoperative renal function. Results There was no significant difference between the two suture groups with respect to patient and tumor characteristics, postoperative creatinine level, and blood urea nitrogen (BUN) level. The modified suture group showed a significantly shorter clamping time and a less GFR level reduction than the traditional two-layer suture group (15 vs. 23 min; 42.32 ± 9.48 vs. 27.07 ± 7.88; p < 0.05). Additionally, the modified two-layer suture was an independent factor that influenced the clamping time and the level of GFR reduction. Conclusion The modified two-layer suture method is feasible and effective for LPN.
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Affiliation(s)
- Yang Jin
- Medical Research Center, Hospital Affiliated to Binhai University, Qingdao, China
| | - Hui Xiong
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qinghua Xia
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qi Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Qi Zhang
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Marchioni M, Amparore D, Ingels A, Carbonara U, Pecoraro A, Roussel E, Campi R. Renal tumors ablation. Minerva Urol Nephrol 2021; 73:549-551. [PMID: 34494416 DOI: 10.23736/s2724-6051.21.04605-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Michele Marchioni
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Alexandre Ingels
- Department of Urology, APHP, Henri Mondor University Hospital, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, Paris Saclay University, Villejuif, France
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Angela Pecoraro
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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