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Eissa A, Rodriguez Peñaranda N, Ticonosco M, Resca S, Piro A, Amato M, Ferretti S, Elsherbiny A, El-Bahnasy A, Zoeir A, Hagras A, Abdel Raheem A, Boggi U, Furian L, Territo A, Farahat Y, Bianchi G, Güven S, Puliatti S, Gozen A, Micali S. Urologists' proficiency in various donor nephrectomy approaches: a real-life survey, systematic review, and meta-analysis of randomized controlled trials. Minerva Urol Nephrol 2024; 76:399-422. [PMID: 39051889 DOI: 10.23736/s2724-6051.24.05789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Donor nephrectomy (DN) is a unique surgical procedure in urological practice, as it involves exposing a healthy individual to the potential risks of surgery. This type of surgery exhibits heterogeneity in terms of approach (open, laparoscopic, or robotic), each with its unique set of advantages and disadvantages. Consequently, there is currently a lack of universally agreed upon clear guidelines. In these settings, this study aims to evaluate transplantation surgeons' knowledge through a real-life survey and compare it with data from published randomized controlled trials (RCTs). EVIDENCE ACQUISITION The study is divided into two parts, with the first part focusing on the outcomes of the real-life survey designed to assess surgeons' knowledge about different DN approaches and their real-world practices during the surgery. The second part involves a systematic review and meta-analysis of RCTs, specifically examining the outcomes of different surgical approaches to DN. The systematic review followed the PRISMA Guidelines and involved a search of PubMed and Web of Science for RCTs comparing the outcomes of different DN approaches. The risk of bias was assessed using the RoB-2 tool. The random effect model was mainly used to assess the mean difference of the included studies. EVIDENCE SYNTHESIS The study was conducted between July 2021 and January 2022 and surveyed 50 surgeons, of which 35 participants (70%) completed the survey. Regarding various approaches to DN, 97.14% of surgeons reported having experience with live DN, and 45.72% performed over 15 cases per year. The most performed approach was pure laparoscopic DN (68.57%). Pure laparoscopic DN was the preferred approach for 77.42% of respondents. The review process resulted in 335 articles, of which 35 were eligible for inclusion in the systematic review. In summary, most studies found that laparoscopic approaches, including standard, hand-assisted, LESS-DN, and mini-LDN, resulted in less postoperative pain, better cosmetic, and quicker recovery times compared to open approaches. The main limitation of the current study is the heterogeneity of the included studies. CONCLUSIONS The study provides valuable insights into the practices of renal transplantation surgeons, offering a comprehensive comparison to level 1 studies (RCTs) in the field. It underscores the continued significance of ODN in contemporary practice, particularly in light of recommendations from the EAU guidelines on renal transplantation. This reaffirms the need to consider the advantages and disadvantages of various approaches, including factors such as cost, postoperative pain, and cosmetic outcomes. While robotic-assisted DN holds promise, their adoption remains variable, potentially due to limited robust evidence.
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Affiliation(s)
- Ahmed Eissa
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | | | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Resca
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Adele Piro
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Elsherbiny
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | | | - Ahmed Zoeir
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
| | - Ayman Hagras
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
- Sharurah Armed Forces Hospital, Ministry of Defense, Sharurah, Saudi Arabia
| | - Ali Abdel Raheem
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ugo Boggi
- Department of General Surgery, University of Pisa, Pisa, Italy
| | | | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, University of Tanta, Tanta, Egypt
- Sheikh Khalifa General Hospital, Umm al-Quwain, United Arab Emirates
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ali Gozen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Mesnard B, De Vergie S, Branchereau J, Prudhomme T. Exploring the correlation between arterial clamping duration during kidney surgeries and kidney partial oxygen pressure levels. World J Urol 2024; 42:363. [PMID: 38814367 DOI: 10.1007/s00345-024-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Affiliation(s)
- Benoit Mesnard
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France.
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France.
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, Nantes University Hospital, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France
| | - Thomas Prudhomme
- Nantes Université, CHU Nantes1, INSERM, Centre for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, 44000, Nantes, France
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
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Caye P, Gasparotto JC, Hörbe AV, Andrade LRL, Reinstein RDS, Mangini LT, Müller DCDM, Brun MV. Case report: Is bilateral renal dioctophymosis and severe uremia in a dog synonymous of euthanasia? Not today. Front Vet Sci 2024; 11:1396467. [PMID: 38840630 PMCID: PMC11150568 DOI: 10.3389/fvets.2024.1396467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
A dog with bilateral renal dioctophymosis presented with stage 5 acute kidney injury, weight loss, vomiting, apathy, and hematuria. Laboratory tests showed creatinine of 17.2 mg/dL and Dioctophyme renale eggs in the urine. It underwent a 30-min session of hyperbaric oxygen preconditioning at a pressure of 2 ATA. Subsequently, bilateral nephroscopy was performed, without warm ischemia, using Amplatz-type renal dilators. Five parasites were removed, three females from the right kidney, one female from the left kidney, and one male from the abdominal cavity. After surgery, the patient continued doing daily hyperbaric oxygen therapy (HBOT) sessions and clinical therapy. Postoperative care consisted of analgesics, antimicrobials, antioxidants, gastric protector and fluid therapy. Ultrasound monitoring showed a reduction in the area of renal dilation and the hematological and biochemical tests showed rapid recovery from acute kidney injury. There was no bacterial growth in the urine sample collected directly from the kidneys. The patient had an excellent clinical progression and was discharged from hospital 7 days postoperatively, with creatinine values of 2.9 mg/dL. This is the first report of the use of nephroscopy in the treatment of dioctophymosis and indicates excellent chances of cure even in severe cases of bilateral parasitosis. HBOT was shown to be an ally in the clinical therapy of patients with D. renale by helping with stabilization and postoperative recovery.
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Affiliation(s)
- Pâmela Caye
- Postgraduate Program in Veterinary Medicine, Center for Rural Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Jean Carlos Gasparotto
- Postgraduate Program in Veterinary Medicine, Center for Rural Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Anna Vitória Hörbe
- Residency Program in Veterinary Medicine, University Veterinary Hospital, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Rainer da Silva Reinstein
- Postgraduate Program in Veterinary Medicine, Center for Rural Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | - Luiza Tonietto Mangini
- Postgraduate Program in Veterinary Medicine, Center for Rural Sciences, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Maurício Veloso Brun
- Department of Small Animal Clinic, Rural Science Center, Federal University of Santa Maria, Santa Maria, Brazil
- Brazilian National Council for Scientific and Technological Development (CNPq) Research Productivity Scholarship-Level 1C (3304353/2021-3), Brazil
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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. Single-layer versus double-layer renorrhaphy technique during robot-assisted partial nephrectomy: impact on perioperative outcomes, complications, and functional outcomes. Minerva Urol Nephrol 2024; 76:176-184. [PMID: 38742552 DOI: 10.23736/s2724-6051.24.05700-8] [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: 05/16/2024]
Abstract
BACKGROUND The debate between single-layer and double-layer renorrhaphy techniques during robot-assisted partial nephrectomy (RPN) represents a subject of ongoing discourse. The present analysis aims to compare the perioperative and functional outcomes of single- versus double-layer renorrhaphy during RPN. METHODS Study data were retrieved from prospectively maintained institutional database (Jan2018-May2023). Study population was divided into two groups according to the number of layers (single vs. double) used for renorrhaphy. Baseline and perioperative data were compared. Postoperative surgical outcomes included type and grade of complications as classified according to Clavien-Dindo. Serum creatinine and estimated glomerular filtration rate were used to measure renal function. RESULTS Three hundred seventeen patients were included in the analysis: 209 received single-layer closure, while 108 underwent double-layer renorrhaphy. Baseline characteristics were not statistically different between the groups. Comparable low incidence of intraoperative complications was observed between the cohorts (P=0.5). No difference was found in terms of mean (95% CI) Hb level drop postoperation (single-layer: 1.6 g/dL [1.5-1.7] vs. double-layer: 1.4 g/dL [1.2-1.5], P=0.3). Overall and "major" rate of complications were 16% and 3%, respectively, with no difference observed in terms of any grade (P=0.2) and major complications (P=0.7). Postoperative renal function was not statistically different between the treatment modalities. At logistic regression analyses, no difference in terms of probability of overall (OR 0.82 [0.63-1.88]) and major (OR 0.94 [0.77-6.44]) complications for the number of suture layers was observed. CONCLUSIONS Single-layer and double-layer renorrhaphy demonstrated comparable perioperative and functional outcomes within the setting of the present study.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy -
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Vincenzo DE Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Antonio B Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
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Tian YQ, Ren X, Yin YS, Wang J, Li X, Guo ZH, Zeng XY. Analysis of risk factors affecting the postoperative drainage after a laparoscopic partial nephrectomy: a retrospective study. Front Med (Lausanne) 2024; 11:1327882. [PMID: 38327705 PMCID: PMC10847592 DOI: 10.3389/fmed.2024.1327882] [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: 10/25/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose Laparoscopic partial nephrectomy (LPN) remains the most commonly used measure for treating localized renal cell cancer (RCC) with an increasing incidence of RCC ever since the 1990s. This study aimed to identify risk factors that affect the postoperative time of drainage and total drainage volume after LPN. Method The clinical data of 612 RCC patients who received LPN from January 2012 to December 2022 in our hospital, including the postoperative drainage time and total drainage volume, were retrospectively analyzed. Univariable and multivariable linear regression and correlation analyses were used to identify the correlations between 21 factors, which include gender, age, history of alcohol consumption, family history of RCC, body weight, body mass index (BMI), and operation time, postoperative drainage time, and total drainage volume. Results The mean time of drainage was 3.52 ± 0.71 days (range: 2 to 8 days), with an average total drainage volume of 259.83 ± 72.64 mL (range: 50 to 620 mL). Both univariable and multivariable linear regression analyses revealed several statistically significant associations. Gender (p = 0.04), age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.032), operation time (p = 0.014), and BMI (p = 0.023) were identified as significant factors associated with the time of drainage. On the other hand, age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.006), and BMI (p = 0.016) emerged as independent risk factors influencing the total drainage volume. Conclusion The duration of postoperative drainage was found to be associated with gender, age, smoking history, diabetes, operation time, and BMI. In contrast, the total drainage volume was primarily influenced by age, smoking history, diabetes, and high BMI following LPN. For patients with these conditions, meticulous attention to hemostasis and bleeding control is crucial during the perioperative period.
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Affiliation(s)
- Yi-Qun Tian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xiang Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Yi-Sheng Yin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Jing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xing Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Zi-Hao Guo
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xiao-Yong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
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Napolitano L, Maggi M, Sampogna G, Bianco M, Campetella M, Carilli M, Lucci Chiarissi M, Civitella A, DE Vita F, DI Maida F, DI Mauro M, Ercolino A, Fasulo V, Felici G, Gheza A, Guzzardo C, Loizzo D, Mazzone E, Parodi S, Piramide F, Rabito S, Rizzetto R, Romantini F, Scarcella S, Tedde M, Checcucci E, Esperto F, Claps F, Falagario U. A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program. Minerva Urol Nephrol 2023; 75:718-728. [PMID: 37350584 DOI: 10.23736/s2724-6051.23.05257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Martina Maggi
- Department of Urology, Sapienza University, Rome, Italy -
| | - Gianluca Sampogna
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bianco
- Department of Urology, University of Padua, Padua, Italy
| | | | - Marco Carilli
- Unit of Urology, Tor Vergata Polyclinic Foundation, Rome, Italy
| | | | - Angelo Civitella
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Fabrizio DI Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marina DI Mauro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | | | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alberto Gheza
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Davide Loizzo
- Unit of Transplantation, Department of Urology, Andrology and Kidney, University of Bari, Bari, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Parodi
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy
| | - Federico Piramide
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Salvatore Rabito
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Rizzetto
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Matteo Tedde
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, Sassari, Italy
| | - Enrico Checcucci
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Esperto
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Ugo Falagario
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
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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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Roussel E, Amparore D, Bertolo R, Pecoraro A, Campi R, Mottrie A. "Sutureless success:" can new devices make renorrhaphy after partial nephrectomy obsolete? Minerva Urol Nephrol 2023; 75:788-790. [PMID: 38126295 DOI: 10.23736/s2724-6051.23.05642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Urology, OLV Hospital Aalst, Aalst, Belgium
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
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Paciotti M, Piramide F, Bravi CA, Dell'oglio P, Turri F, DI Maida F, DE Groote R, Lambert E, Wurnschimmel C, Larcher A. Retroperitoneal approach for robot-assisted partial nephrectomy: still underused despite the supporting evidence. Minerva Urol Nephrol 2023; 75:652-655. [PMID: 37728499 DOI: 10.23736/s2724-6051.23.05530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Piramide
- Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy -
| | - Carlo A Bravi
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Paolo Dell'oglio
- Department of Urology, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Fabrizio DI Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Ruben DE Groote
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Edward Lambert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Di Maida F, Cadenar A, Mari A, Minervini A. Re: Xuesong Li, Weifeng Xu, Shubo Fan, et al. Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial. Eur Urol Focus 2023:9:133-40. Eur Urol Focus 2023; 9:853-854. [PMID: 37028985 DOI: 10.1016/j.euf.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
| | - Anna Cadenar
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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Li H, Hu Y, Lu D, Wang J, Lin Y, Zhong X, Mou Y, Yao C, Wang Z, Zhang X, Wo Q, Liu H, Liu F, Zhang D, Wang H. Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy. Front Oncol 2023; 13:1212696. [PMID: 37675217 PMCID: PMC10478230 DOI: 10.3389/fonc.2023.1212696] [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: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer. Methods We retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed. Results All operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred. Conclusion For patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.
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Affiliation(s)
- Haichang Li
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yuning Hu
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Dongning Lu
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Jingyun Wang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yanze Lin
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xugang Zhong
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yixuan Mou
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Cenchao Yao
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Zhida Wang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xinyu Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Qijun Wo
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Hanbo Liu
- Cancer Center, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Feng Liu
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Dahong Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Heng Wang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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12
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Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S. Simplifying Retroperitoneal Robotic Single-port Surgery: Novel Supine Anterior Retroperitoneal Access. Eur Urol 2023; 84:223-228. [PMID: 37211448 DOI: 10.1016/j.eururo.2023.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Multiport robotic surgery in the retroperitoneum is limited by the bulky robotic frame and clashing of instruments. Moreover, patients are placed in the lateral decubitus position, which has been linked to complications. OBJECTIVE To assess the feasibility and safety of a supine anterior retroperitoneal access (SARA) technique with the da Vinci Single-Port (SP) robotic platform. DESIGN, SETTING, AND PARTICIPANTS Between October 2022 and January 2023, 18 patients underwent surgery using the SARA technique for renal cancer, urothelial cancer, or ureteral stenosis. Perioperative variables were prospectively collected and outcomes were assessed. SURGICAL PROCEDURE With the patient in a supine position, a 3-cm incision is made at the McBurney point and the abdominal muscles are dissected. Finger dissection is used to develop the retroperitoneal space for the da Vinci SP access port. After docking, the first step is to dissect retroperitoneal tissue to reveal the psoas muscle. This allows identification of the ureter, the inferior renal pole, and the hilum. MEASUREMENTS A descriptive statistical analysis was performed. Data collected included demographics, operative time, warm ischemia time (WIT), surgical margin status, complications, length of hospital stay, 30-d Clavien-Dindo complications, and postoperative narcotic use. RESULTS AND LIMITATIONS Twelve patients underwent partial nephrectomy (PN) and two each underwent pyeloplasty, radical nephroureterectomy, and radical nephrectomy. In the PN group, mean age was 57 yr (interquartile range [IQR] 30-73), median body mass index was 32 kg/m2 (IQR 17-58), and 25% had stage ≥3 chronic kidney disease. The median Charlson comorbidity index was 3 (IQR 0-7) and 75% of PN patients had an American Society of Anesthesiologists score ≥3. The median RENAL score was 5 (IQR 4-7). The median WIT was 25 min (IQR 16-48) and the median tumor size was 35 mm (IQR 16-50). The median estimated blood loss was 105 ml (IQR 20-400) and the median operative time was 160 min (IQR 110-200). Positive surgical margins were found in one patient. In the overall cohort, one patient was readmitted and managed conservatively; 83% of the PN group were discharged on the same day as their surgery, with the remainder discharged the next day. At 7 d after surgery, no patients reported narcotic use. CONCLUSIONS The SARA approach is feasible and safe. Larger studies are needed to confirm this approach as a one-step solution for upper urinary tract surgery. PATIENT SUMMARY We assessed initial outcomes of a novel approach for accessing the retroperitoneum (the space behind the abdominal cavity and in front of the back muscles and spine) during robot-assisted surgery in the upper urinary tract. The patient is placed on their back and surgery is performed with a single-port robot. Our results show that this approach was feasible and safe, with low complication rates, less postoperative pain, and earlier discharge. This is a promising start, but larger studies are needed to confirm our findings.
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Affiliation(s)
- Antony A Pellegrino
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Grace Chen
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - 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
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
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Liu X, Jin D, Zhang Y, Zhang S. Limited non-linear impact of warm ischemia time on renal functional decline after partial nephrectomy: a propensity score-matched study. Int Urol Nephrol 2023:10.1007/s11255-023-03630-0. [PMID: 37191733 DOI: 10.1007/s11255-023-03630-0] [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: 03/10/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To quantificationally illustrate the impact of ischemia time (IT) on renal function decline after partial nephrectomy (PN), especially for patients with compromised baseline renal function (estimated glomerular filtration rate [eGFR] < 90 mL/min/1.73 m2). METHODS Patients undergoing PN during 2014-2021 from a prospectively maintained database were reviewed. Propensity score matching (PSM) was employed to balance the possible covariates between patients with or without baseline compromised renal function. Specifically, the relationship of IT with postoperative renal function was illustrated. Two machine learning methods (logistic least absolute shrinkage and selection operator [LASSO] logistic regression and random forest) were applied to quantify the relative impact of each covariables. RESULTS The average drop percent of eGFR was -10.9% (- 12.2%, - 9.0%). Multivariable Cox proportional regression and linear regression analyses identified five risk factors for renal function decline, namely RENAL Nephrometry Score (RNS), age, baseline eGFR, diabetes and IT (all p < 0.05). Specifically, the relationship of IT with postoperative functional decline emerged as non-linear, with an increase from 10-30 min and a plateau afterwards among patients with normal function (eGFR ≥ 90 mL/min/1.73 m2), whereas with an increase from 10 to 20 min and a plateau afterwards among patients with compromised function (eGFR < 90 mL/min/1.73 m2). Furthermore, the coefficient's path and random forest analysis revealed that the top two most important features were RNS and age. CONCLUSION IT exhibits the secondarily non-linear relationship with postoperative renal function decline. Patients with compromised baseline renal function are less tolerant to ischemia damage. The use of a single cut-off interval of IT in the setting of PN is flawed.
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Affiliation(s)
- Xudong Liu
- Department of Urology, Chongqing Bishan Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China
| | - Dachun Jin
- Department of Urology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Urology, Daping Hospital/Army Medical Center, Army Medical University, Chongqing, People's Republic of China
| | - Yuanfeng Zhang
- Department of Urology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Sizhou Zhang
- Department of Urology, People's Hospital of Chongqing Hechuan, Chongqing, 401520, People's Republic of China.
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Surgical Management of Synchronous, Bilateral Renal Masses: A 1-decade Referral Center Experience. Eur Urol Focus 2022; 8:1309-1317. [PMID: 35123928 DOI: 10.1016/j.euf.2022.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Management and decision-making in patients with bilateral renal masses are controversial. OBJECTIVE To report our experience of surgical management in patients with bilateral renal masses undergoing surgery at a high-volume center. DESIGN, SETTING, AND PARTICIPANTS We retrospectively collected data from patients treated with partial nephrectomy (PN) or radical nephrectomy for bilateral renal masses at a single referral institution between June 2008 and June 2019. Patient- and tumor-related features, timing (one vs two stage), and surgical approach (open vs robotic) were analyzed. SURGICAL PROCEDURE A one- versus two-stage strategy was adopted according to the opportunity to perform at least one PN using a clampless or selective-clamping approach, in order to avoid acute kidney injury. MEASUREMENTS Operative time, warm ischemia time, and intra- and postoperative complications were recorded. Histopathological results and tumor histology were assessed. RESULTS AND LIMITATIONS Overall, 41 patients were included. The median age was 67 yr and the median preoperative estimated glomerular filtration rate (eGFR) was 84 ml/min/1.73 m2. The median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (interquartile range [IQR] 7-8) for both sides. In 17 (42%) patients, a simultaneous approach was chosen, with a pure robotic approach in 11/17 cases, while among the 24 (58.6%) patients treated with a two-stage strategy, 15 (62.5%) were treated with a robotic approach on both sides. Intraoperative complications and postoperative major (CDC ≥3) complications were recorded in 7.3% and 4.9% of cases, respectively. The overall positive surgical margins rate was 2.4%. At a median follow-up of 42 (IQR 18-59) mo, the median eGFR was 73 (IQR 64-80) ml/min/1.73 m2, while disease-free survival and cancer-specific mortality were 90.2% and 7.3%, respectively. CONCLUSIONS Our experience underlines that both simultaneous and staged surgical treatment of patients with bilateral renal masses are feasible and safe if grounded on proper patient selection. PATIENT SUMMARY Management of patients with bilateral renal masses is challenging, given the heterogeneity of clinical scenarios and the need to optimize the timing of treatment to achieve maximal functional preservation while ensuring oncological efficacy.
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Bai Y, Yang Y, Wei H, Quan J, Wei F, Zhang Q, Liu F. Clinical outcomes of robotic-assisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors. Front Oncol 2022; 12:918143. [PMID: 36091113 PMCID: PMC9459104 DOI: 10.3389/fonc.2022.918143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/18/2022] [Indexed: 12/09/2022] Open
Abstract
Objective This study aimed to investigate the safety and efficacy of renal hypothermic perfusion by renal artery balloon catheter during robot-assisted laparoscopic partial nephrectomy (P-RALPN) for patients with complex renal tumors. Materials and methods We retrospectively identified 45 patients with complex renal tumors who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN) and 11 patients treated with P-RALPN from September 2017 to October 2021. Preoperative patients’ characteristics and intraoperative surgical parameters including operating time, blood loss, hospitalization, pre- and post-surgical glomerular filtration rate (GFR), and postoperative survival time were collected and compared between the two groups. The patients’ body temperature, real-time kidney temperature, and short-term renal function were analyzed in the P-RALPN group. Results There was no statistically significant difference on median intraoperative estimated blood loss and postoperative hospitalization between the two groups. Patients who received P-RALPN had a slightly longer operative time than those who received S-RALPN (103.1 versus 125.9; p = 0.09). In the P-RALPN group, the volume of perfusion solution was 533.2 ml (range, 255.0–750.0 ml), the median temperature of kidney was 22.6°C (range, 21.7–24.1°C) after the kidney cools down, and the median minimum intraoperative temperature of patients was 36.1°C (range 35.2–36.7°C). The ischemia time in the S-RALPN group was markedly lower than that in the P-RALPN group (21.5 versus 34.8; p < 0.01). However, the loss of GFR was much higher for the S-RALPN group after the surgery. (28.9 versus 18.4; p < 0.01). Importantly, patients had similar postoperative survival time between the two groups (p = 0.42; HR = 0.27). Conclusion P-RALPN is a safe and feasible surgery in the treatment of patients with complex renal tumors, which provides a new operative approach for clinicians to treat these patients.
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Affiliation(s)
- YuChen Bai
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - YunKai Yang
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - HaiBin Wei
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Quan
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Fei Wei
- Graduate Department, Bengbu Medical College, Bengbu, China
| | - Qi Zhang
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
- *Correspondence: Feng Liu, ; Qi Zhang,
| | - Feng Liu
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, China
- *Correspondence: Feng Liu, ; Qi Zhang,
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Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081041. [PMID: 36013508 PMCID: PMC9412454 DOI: 10.3390/medicina58081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien−Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien−Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
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Bertolo R, Bove P, Sandri M, Cindolo L, Annino F, Leonardo C, Parma P, Nucciotti R, Porreca A, Falsaperla M, Veneziano D, Celia A, Schips L, Simeone C, Carini M, Minervini A, Antonelli A. Cross-analysis of two randomized controlled trials to compare pure versus robot-assisted laparoscopic approach during off-clamp partial nephrectomy. Minerva Urol Nephrol 2022; 74:5-10. [PMID: 35272452 DOI: 10.23736/s2724-6051.22.04779-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy -
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.,Urology Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Marco Sandri
- Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Luca Cindolo
- Unit of Urology, Villa Stuart Private Hospital, Rome, Italy
| | | | | | - Paolo Parma
- Department of Urology, Carlo Poma Hospital, Mantova, Italy
| | | | - Angelo Porreca
- Unit of Urology, Polyclinic of Abano, Abano Terme, Padua, Italy
| | | | - Domenico Veneziano
- Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Luigi Schips
- Unit of Urology, SS Annunziata Hospital, University of Chieti, Chieti, Italy
| | - Claudio Simeone
- Unit of Urology, Spedali Civili Hospital, University of Brescia, 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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