1
|
Kikkawa K, Maruno K, Hazama T, Takahashi T, Yamada Y, Nakashima M, Tamaki M, Ito N. Robotic-assisted partial nephrectomy for a neuroendocrine tumor in a horseshoe kidney: a case report. J Surg Case Rep 2024; 2024:rjae292. [PMID: 38711819 PMCID: PMC11070646 DOI: 10.1093/jscr/rjae292] [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: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
Neuroendocrine tumors of the kidney are exceedingly rare. We report the first case of robotic-assisted partial nephrectomy for such tumors in horseshoe kidneys. A 65-year-old woman was incidentally found to have a 27 mm renal mass in the isthmus of her horseshoe kidney during computed tomography. Based on contrast-enhanced computed tomography results, we initially suspected renal cell carcinoma originating from the horseshoe kidney. Subsequently, robotic-assisted partial nephrectomy with isthmus transection was performed. Intraoperatively, we adjusted the port position for camera insertion and the patient's positioning to facilitate better visualization for dorsal isthmus and vessel dissection. Pathological examination and immunohistochemical analysis revealed a well-differentiated neuroendocrine tumor. Therefore, robotic-assisted partial nephrectomy is a safe and effective approach for managing neuroendocrine tumors in the isthmus of horseshoe kidneys. Given the nonspecific clinical presentation of renal neuroendocrine tumors and their rarity, the optimal management of these tumors remains controversial.
Collapse
Affiliation(s)
- Kazuro Kikkawa
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Kouhei Maruno
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Tatsuya Hazama
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Toshifumi Takahashi
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Yuya Yamada
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Masakazu Nakashima
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Masahiro Tamaki
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, 4-20, Komatsubaradori, Wakayama 640-8558, Japan
| |
Collapse
|
2
|
Williams Z, Ananthapadmanabhan S, Ranasinghe S, Thangasamy I. Three-dimensional virtual reconstruction guides robot-assisted partial nephrectomy in a horseshoe kidney. BJU Int 2024; 133 Suppl 4:64-67. [PMID: 38178790 DOI: 10.1111/bju.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Zoe Williams
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
| | | | - Sachinka Ranasinghe
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
| | - Isaac Thangasamy
- Nepean Hospital, Kingswood, New South Wales, Australia
- Nepean Urology Research Group, Kingswood, New South Wales, Australia
| |
Collapse
|
3
|
Mahmud S, Abbas TO, Mushtak A, Prithula J, Chowdhury MEH. Kidney Cancer Diagnosis and Surgery Selection by Machine Learning from CT Scans Combined with Clinical Metadata. Cancers (Basel) 2023; 15:3189. [PMID: 37370799 DOI: 10.3390/cancers15123189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Kidney cancers are one of the most common malignancies worldwide. Accurate diagnosis is a critical step in the management of kidney cancer patients and is influenced by multiple factors including tumor size or volume, cancer types and stages, etc. For malignant tumors, partial or radical surgery of the kidney might be required, but for clinicians, the basis for making this decision is often unclear. Partial nephrectomy could result in patient death due to cancer if kidney removal was necessary, whereas radical nephrectomy in less severe cases could resign patients to lifelong dialysis or need for future transplantation without sufficient cause. Using machine learning to consider clinical data alongside computed tomography images could potentially help resolve some of these surgical ambiguities, by enabling a more robust classification of kidney cancers and selection of optimal surgical approaches. In this study, we used the publicly available KiTS dataset of contrast-enhanced CT images and corresponding patient metadata to differentiate four major classes of kidney cancer: clear cell (ccRCC), chromophobe (chRCC), papillary (pRCC) renal cell carcinoma, and oncocytoma (ONC). We rationalized these data to overcome the high field of view (FoV), extract tumor regions of interest (ROIs), classify patients using deep machine-learning models, and extract/post-process CT image features for combination with clinical data. Regardless of marked data imbalance, our combined approach achieved a high level of performance (85.66% accuracy, 84.18% precision, 85.66% recall, and 84.92% F1-score). When selecting surgical procedures for malignant tumors (RCC), our method proved even more reliable (90.63% accuracy, 90.83% precision, 90.61% recall, and 90.50% F1-score). Using feature ranking, we confirmed that tumor volume and cancer stage are the most relevant clinical features for predicting surgical procedures. Once fully mature, the approach we propose could be used to assist surgeons in performing nephrectomies by guiding the choices of optimal procedures in individual patients with kidney cancer.
Collapse
Affiliation(s)
- Sakib Mahmud
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Tariq O Abbas
- Urology Division, Surgery Department, Sidra Medicine, Doha 26999, Qatar
- Department of Surgery, Weill Cornell Medicine-Qatar, Doha 24811, Qatar
- College of Medicine, Qatar University, Doha 2713, Qatar
| | - Adam Mushtak
- Clinical Imaging Department, Hamad Medical Corporation, Doha 3050, Qatar
| | - Johayra Prithula
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka 1000, Bangladesh
| | | |
Collapse
|
4
|
Wang L, Deng JY, Liang C, Zhu PY. Perioperative, functional, and oncological outcomes of robotic vs. laparoscopic partial nephrectomy for complex renal tumors (RENAL score ≥7): an evidence-based analysis. Front Oncol 2023; 13:1195910. [PMID: 37664014 PMCID: PMC10472455 DOI: 10.3389/fonc.2023.1195910] [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: 03/29/2023] [Accepted: 05/19/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To evaluate the current literature comparing outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) treating complex renal tumors (RENAL nephrometry score ≥7). Methods We systematically searched the Cochrane Library, PubMed, Google Scholar, EMBASE, and Scopus databases up to March 2023. Review Manager 5.4 performed a pooled analysis of the data for random effects. Besides, sensitivity and subgroup analyses to explore heterogeneity, Newcastle-Ottawa scale, and GRADE to evaluate study quality and level of evidence. Results Eight observational studies comprising 1346 patients (RPN: 695; LPN: 651) were included in this study. Compared to LPN, RPN had a shorter operative time (OT) (weight mean difference [WMD]: -14.73 min; p = 0.0003), shorter warm ischemia time (WIT) (WMD: -3.47 min; p = 0.002), lower transfusion rate (odds ratio [OR]: 0.66; p = 0.04), shorter length of stay (LOS) (WMD: -0.65 days; p < 0.00001), lower postoperative estimated glomerular filtration rate (eGFR) change (WMD = -2.33 mL/min/1.73 m2; p = 0.002) and lower intraoperative complications (OR: 0.52; p = 0.04). No significant differences were observed between the two groups in terms of estimated blood loss (EBL) (p = 0.84), conversion to radical nephrectomy (p = 0.12), postoperative complications (p = 0.11), major complications (defined Clavien-Dindo grade 3 (p = 0.43), overall complications (p = 0.15), postoperative eGFR (p = 0.28), local recurrence (p = 0.35), positive surgical margin (PSM) (p = 0.63), overall survival (OS) (p = 0.47), cancer-specific survival (CSS) (p = 0.22) and 3-year recurrence-free survival (RFS) (p = 0.53). Conclusion Patients with complex renal tumors (RENAL score ≥7), RPN is superior to LPN in decreasing the OT, WIT, LOS, transfusion rate, change in eGFR and the incidence of intraoperative complications while maintaining oncological control and avoiding a decline in renal function. However, our findings need further validation in a large-sample prospective randomized study.
Collapse
Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing-ya Deng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cai Liang
- Department of General Medicine, The Second Affiliated Hospital of North Sichuan Medical College (Mianyang 404 Hospital), Sichuan, China
| | - Ping-yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| |
Collapse
|
5
|
Traumatic renal injury revealing a horseshoe kidney: A case report. Urol Case Rep 2023; 47:102357. [PMID: 36860417 PMCID: PMC9969272 DOI: 10.1016/j.eucr.2023.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
Having a kidney disease is a major risk factor of renal injury during blunt traumas. We present a case of abdominal blunt trauma due to motor-vehicle accident in a 48 year old male patient. Abdominal computed tomography scan showed a high-volume retroperitoneal hematoma with rupture in the isthmus of the horseshoe kidney with active contrast-enhanced extravasation. He underwent a partial nephrectomy of the left lower pole.
Collapse
|
6
|
Harrison R, Iarajuli T, Kim K, Ahmed M, Munver R, Stifelman M. A Guide to Utilizing Iris, a Segmented Three-Dimensional Model, to Improve Surgical Planning and Patient Outcomes During Robotic Partial Nephrectomy. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Holmes A, Tissot S, O'Neill S, Kearns P. Intraoperative indocyanine green fluorescence navigation in a robot-assisted partial nephrectomy for a large renal cell carcinoma in a horseshoe kidney. BMJ Case Rep 2022; 15:15/6/e248323. [PMID: 35725279 PMCID: PMC9214297 DOI: 10.1136/bcr-2021-248323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 60s was referred to the urology department with an incidental finding of large 75 mm mass within a horseshoe kidney. CT imaging highlighted the well-known aberrant arterial anatomy seen in horseshoe kidney which often causes significant surgical challenges.After careful preoperative planning, the mass was resected successfully during a robot-assisted partial nephrectomy. Intraoperatively, indocyanine green fluorescence navigation helped to confirm arteries supplying area of resection were appropriately clamped, allowing for safe resection of the mass. Histology revealed a chromophobe renal cell carcinoma with clear margins. The patient was discharged on day 4 postoperatively and continues to be cancer free on routine surveillance imaging.
Collapse
Affiliation(s)
- Angela Holmes
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Sophie Tissot
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Sarah O'Neill
- Urology, Barwon Health, Geelong, Victoria, Australia
| | - Paul Kearns
- Urology, Barwon Health, Geelong, Victoria, Australia
| |
Collapse
|
8
|
Puliatti S, Eissa A, Checcucci E, Piazza P, Amato M, Scarcella S, Rivas JG, Taratkin M, Marenco J, Rivero IB, Kowalewski KF, Cacciamani G, El-Sherbiny A, Zoeir A, El-Bahnasy AM, De Groote R, Mottrie A, Micali S. New imaging technologies for robotic kidney cancer surgery. Asian J Urol 2022; 9:253-262. [PMID: 36035346 PMCID: PMC9399539 DOI: 10.1016/j.ajur.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
Collapse
|
9
|
Amparore D, Piramide F, Pecoraro A, Verri P, Checcucci E, De Cillis S, Piana A, Busacca G, Manfredi M, Fiori C, Porpiglia F. Identification of Recurrent Anatomical Clusters Using Three-dimensional Virtual Models for Complex Renal Tumors with an Imperative Indication for Nephron-sparing Surgery: New Technological Tools for Driving Decision-making. EUR UROL SUPPL 2022; 38:60-66. [PMID: 35265865 PMCID: PMC8898779 DOI: 10.1016/j.euros.2022.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
| | - Federico Piramide
- 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 Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
| | - Paolo Verri
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
- European Association of Urology Young Academic Urologists Uro-technology and SoMe Working Group, Arnhem, The 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
| | - Giovanni Busacca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, 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
- Corresponding author. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy. Tel. +39 011 9026485; Fax: +39 011 9026244.
| |
Collapse
|