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Piana A, Chiaravalloti F, Chiaradia F, Greco A, Lauria J, Zappalà G, Cappa M, Pagliarulo V, Pullano C, Checcucci E, Amparore D, Di Dio M, Scarcia M, Porpiglia F, Alba S. A New Concept for Minimally Invasive Surgical Treatment in Renal Cancer: The Use of Neuroaxial Anesthesia During Laparoscopic Partial Nephrectomy. EUR UROL SUPPL 2023; 57:16-21. [PMID: 37780175 PMCID: PMC10539894 DOI: 10.1016/j.euros.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
A new concept for minimally invasive treatment involves abdominal laparoscopic surgery performed while the patient breathes independently without losing consciousness. Here we report the first series of laparoscopic partial nephrectomy (LPN) performed under neuroaxial anesthesia (NA). From May 2021 to September 2022 we prospectively enrolled selected patients with an organ-confined single renal mass to undergo LPN under NA. Anesthesia was administered using an epidural catheter placed at the level of T7, with additional anesthesia at the level of T10. The rationale was to avoid use of a tracheal tube and the side effects of general anesthesia. Ten patients were enrolled in the study. Targeted sedation was achieved in all cases. In one case, a switch to general anesthesia was needed because of patient anxiety. Food intake started at 12 h after surgery in 9/10 cases; mobilization started from 3 h after surgery. The length of hospital stay was 3 d in 4/10 cases and 4 d in 3/10 cases. This first experience worldwide of LPN performed under NA demonstrates the feasibility and safety of the procedure.
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Affiliation(s)
- Alberto Piana
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | | | - Antonio Greco
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Jacopo Lauria
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Giulio Zappalà
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - Manlio Cappa
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | | | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, Annunziata Hospital, Cosenza, Italy
| | - Marcello Scarcia
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefano Alba
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
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Porpiglia F, Mari A, Amparore D, Fiori C, Antonelli A, Artibani W, Bove P, Brunocilla E, Capitanio U, Da Pozzo L, Di Maida F, Gontero P, Longo N, Marra G, Rocco B, Schiavina R, Simeone C, Siracusano S, Tellini R, Terrone C, Villari D, Ficarra V, Carini M, Minervini A. Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project). Surg Endosc 2020; 35:4295-4304. [PMID: 32856156 PMCID: PMC8263535 DOI: 10.1007/s00464-020-07919-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). MATERIAL AND METHODS All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. RESULTS 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. CONCLUSIONS The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Di Maida
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Nicola Longo
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Bernardo Rocco
- Department of Urology, Fondazione IRCCS Ca' Granda' Ospedale Maggiore Policlinico' Policlinico' University of Milan, Milan, Italy.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Riccardo Tellini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, University of Genova, Genova, Italy
| | - Donata Villari
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy
| | - Marco Carini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Andrea Minervini
- Division of Urology, Department of Oncology- School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. .,Department of Urology, Careggi Hospital, San Luca Nuovo, University of Florence, Florence, Italy.
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