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Xu P, Luo J, Shuai H, Cai T, Cui S, Zhou L, Xu Q, Zhao Y, Chen T, Shan W, Wu T. Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis. J Robot Surg 2024; 18:186. [PMID: 38683492 DOI: 10.1007/s11701-024-01963-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
The study aims to assess the available literature and compare the perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) for posterior-lateral renal tumors using transperitoneal (TP) and retroperitoneal (RP) approaches. Systematically searched the Embase, PubMed, and Cochrane Library databases for literature. Eligible studies were those that compared TP-RAPN and RP-RAPN for posterior-lateral renal tumors. The data from the included studies were analyzed and summarized using Review Manager 5.3, which involved comparing baseline patient and tumor characteristics, intraoperative and postoperative outcomes, and oncological outcomes. The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). Both groups showed no significant differences in age, gender, BMI, R.E.N.A.L. score, and tumor size. Notably, compared to TP-RAPN, the RP-RAPN group demonstrated shorter operative time (OT) (MD: 17.25, P = 0.01), length of hospital stay (LOS) (MD: 0.37, P < 0.01), and lower estimated blood loss (EBL) (MD: 15.29, P < 0.01). However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). The systematic review and meta-analysis suggests RP-RAPN may be more advantageous for posterior-lateral renal tumors in terms of OT, EBL, and LOS, but no significant differences were found in WIT, overall complications, major complications, and PSM. Both surgical approaches are safe, but a definitive advantage remains uncertain.
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Affiliation(s)
- Pengjun Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jia Luo
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Cai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Shu Cui
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lin Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Qian Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yuxin Zhao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Wang Shan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China.
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China.
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Yamamoto R, Numakura K, Kobayashi M, Nara T, Saito M, Narita S, Habuchi T. Predictive factors of renal function after robot-assisted partial nephrectomy in clinical T1b tumors. J Robot Surg 2024; 18:154. [PMID: 38564051 PMCID: PMC10987366 DOI: 10.1007/s11701-024-01848-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 04/04/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) has been shown to be a safe and effective method for treatment of small renal tumors, including clinical T1b renal cell carcinoma (RCC); however, the impact of RAPN for cT1b renal tumors on renal function is not well understood. In this retrospective study, 50 patients who underwent RAPN for cT1b renal tumors were evaluated for pre- and post-operative renal function and perioperative clinical factors. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at baseline and on postoperative days (POD) 1, 7, 30, and 180.A significant renal functional decline was defined as ≥ 15% reduction in eGFR at POD180 compared with eGFR at baseline. Logistic regression analyses were used to identify risk factors for renal function decline, including age, sex, RENAL nephrometry score, operative time, and estimated blood loss. The median patient age was 62 years, and the median tumor diameter and RENAL nephrometry score were 44 mm (IQR 43-50) and 8 (IQR 7-9), respectively. Of these patients, 16 (36%) showed a significant renal functional decline at POD 180. In the multivariate analysis, the L component of the RENAL nephrometry score and an estimated blood loss of 200 mL or more were identified as significant risk factors for renal functional decline. These findings suggest that the preoperatively definable L component of the RENAL nephrometry score and intraoperative blood loss, which may be modifiable factors, play significant roles in post-RAPN renal function decline.
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Affiliation(s)
- Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Dos Santos Almeida Farinha RJ, Piro A, Mottaran A, Paciotti M, Puliatti S, Breda A, Porter J, Van Cleynenbreugel B, Vander Sloten J, Mottrie A, Gallagher AG. Development and validation of metrics for a new RAPN training model. J Robot Surg 2024; 18:153. [PMID: 38563887 DOI: 10.1007/s11701-024-01911-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) is a complex and index procedure that urologists need to learn how to perform safely. No validated performance metrics specifically developed for a RAPN training model (TM) exist. A Core Metrics Group specifically adapted human RAPN metrics to be used in a newly developed RAPN TM, explicitly defining phases, steps, errors, and critical errors. A modified Delphi meeting concurred on the face and content validation of the new metrics. One hundred percent consensus was achieved by the Delphi panel on 8 Phases, 32 Steps, 136 Errors and 64 Critical Errors. Two trained assessors evaluated recorded video performances of novice and expert RAPN surgeons executing an emulated RAPN in the newly developed TM. There were no differences in procedure Steps completed by the two groups. Experienced RAPN surgeons made 34% fewer Total Errors than the Novice group. Performance score for both groups was divided at the median score using Total Error scores, into HiError and LoError subgroups. The LowErrs Expert RAPN surgeons group made 118% fewer Total Errors than the Novice HiErrs group. Furthermore, the LowErrs Expert RAPN surgeons made 77% fewer Total Errors than the HiErrs Expert RAPN surgeons. These results established construct and discriminative validity of the metrics. The authors described a novel RAPN TM and its associated performance metrics with evidence supporting their face, content, construct, and discriminative validation. This report and evidence support the implementation of a simulation-based proficiency-based progression (PBP) training program for RAPN.
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Affiliation(s)
| | - Adele Piro
- Division of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Puliatti
- Division of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Breda
- Department of Urology, Universitat Autonoma de Barcelona, Fundació Puigvert, Barcelona, Spain
| | - James Porter
- Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Section of Biomechanics, KU Leuven, Leuven, Belgium
| | - Alexandre Mottrie
- Orsi Academy, Proefhoevestraat 12, 9090, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Anthony G Gallagher
- Orsi Academy, Proefhoevestraat 12, 9090, Ghent, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
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Chlorogiannis DD, Kratiras Z, Efthymiou E, Moulavasilis N, Kelekis N, Chrisofos M, Stravodimos K, Filippiadis DK. Percutaneous Microwave Ablation Versus Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma: A Propensity-Matched Cohort Study Focusing Upon Long-Term Follow-Up of Oncologic Outcomes. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03695-z. [PMID: 38561521 DOI: 10.1007/s00270-024-03695-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To retrospectively compare long-term oncologic outcomes of percutaneous computed tomography-guided microwave ablation (MWA) and robot-assisted partial nephrectomy (RAPN) for the treatment of stage 1 (T1a and T1b) renal cell carcinoma (RCC) patients. MATERIALS AND METHODS Institutional database research identified all T1 RCC patients who underwent either MWA or RAPN. Models were adjusted with propensity score matching. Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the oncologic outcomes. Patient and tumor characteristics, technical success as well as oncologic outcomes were evaluated and compared between the 2 groups. RESULTS After propensity score matching, a total of 71 patients underwent percutaneous MWA (mean age 70 ± 10 years) and 71 underwent RAPN (mean age 60 ± 9 years). At 8-year follow-up, the estimated survival rates for MWA cohort were 98% (95% confidence interval [CI] 95-100%) for overall survival, 97% (95% CI 93-100%) for recurrence-free survival, and 97% (95% CI 93-100%) for metastasis-free survival. The matched cohort that underwent RAPN exhibited survival rates of 100% (95% CI 100-100%) for overall survival, 98% (95% CI 94-100%) for recurrence-free survival, and 98% (95% CI 94-100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p values of 0.44, 0.67, and 0.67, respectively). CONCLUSION The results of the present study suggest that both MWA and RAPN are equally effective in terms of oncologic outcome for the treatment of T1 RCC.
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Affiliation(s)
| | - Zisis Kratiras
- 3rd Department of Urology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evgenia Efthymiou
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Napoleon Moulavasilis
- 1st Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Chrisofos
- 3rd Department of Urology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstandinos Stravodimos
- 1st Department of Urology, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kawamura Y, Uchida T, Kano T, Umemoto T, Nakajima N, Nitta M, Hasegawa M, Shoji S, Miyajima A. Transcatheter renal arterial embolization for intractable urinary fistula occurring after robot-assisted partial nephrectomy: a case report. CEN Case Rep 2024:10.1007/s13730-024-00866-2. [PMID: 38502302 DOI: 10.1007/s13730-024-00866-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Partial nephrectomy is the standard surgical procedure for small renal tumors. Since the advent of robot-assisted partial nephrectomy (RAPN), the number of cases of renal tumors undergoing the procedure has increased exponentially. Urinary fistula is a complication of partial nephrectomy. Conservative management using ureteral stents is useful in most cases of urinary fistulas. However, some patients develop intractable urinary fistulas. Herein, we report a case in which vascular embolization was useful for treating an infected and intractable urinary fistula that developed after RAPN. A 59-year-old man was accidentally found to have a right renal tumor (approximately 3 cm in diameter) during a physical examination. Pathology was clear cell carcinoma. RAPN was performed owing to the small size of the renal tumor; however, postoperatively, an intractable urinary fistula with an isolated calyx developed, which was successfully treated with transcatheter renal arterial embolization (TAE). We encountered a rare case of infected refractory urinary fistula with an isolated calyx in which TAE was successful. TAE seems useful in treating intractable urinary fistulas with an isolated calyx occurring after RAPN.
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Affiliation(s)
- Yoshiaki Kawamura
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Takato Uchida
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tatsuo Kano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tatsuya Umemoto
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Nobuyuki Nakajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Flammia RS, Anceschi U, Tuderti G, Di Maida F, Grosso AA, Lambertini L, Mari A, Mastroianni R, Bove A, Capitanio U, Amparore D, Lee J, Pandolfo SD, Fiori C, Minervini A, Porpiglia F, Eun D, Autorino R, Leonardo C, Simone G. Development and internal validation of a nomogram predicting 3-year chronic kidney disease upstaging following robot-assisted partial nephrectomy. Int Urol Nephrol 2024; 56:913-921. [PMID: 37848745 DOI: 10.1007/s11255-023-03832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Aim of the present study was to develop and validate a nomogram to accurately predict the risk of chronic kidney disease (CKD) upstaging at 3 years in patients undergoing robot-assisted partial nephrectomy (RAPN). METHODS A multi-institutional database was queried to identify patients treated with RAPN for localized renal tumor (cT1-cT2, cN0, cM0). Significant CKD upstaging (sCKD-upstaging) was defined as development of newly onset CKD stage 3a, 3b, and 4/5. Model accuracy was calculated according to Harrell C-index. Subsequently, internal validation using bootstrapping and calibration was performed. Then nomogram was depicted to graphically calculate the 3-year sCKD-upstaging risk. Finally, regression tree analysis identified potential cut-offs in nomogram-derived probability. Based on this cut-off, four risk classes were derived with Kaplan-Meier analysis tested this classification. RESULTS Overall, 965 patients were identified. At Kaplan-Meier analysis, 3-year sCKD-upstaging rate was 21.4%. The model included baseline (estimated glomerular filtration rate) eGFR, solitary kidney status, multiple lesions, R.E.N.A.L. nephrometry score, clamping technique, and postoperative acute kidney injury (AKI). The model accurately predicted 3-year sCKD-upstaging (C-index 84%). Based on identified nomogram cut-offs (7 vs 16 vs 26%), a statistically significant increase in sCKD-upstaging rates between low vs intermediate favorable vs intermediate unfavorable vs high-risk patients (1.3 vs 9.2 vs 22 vs 54.2%, respectively, p < 0.001) was observed. CONCLUSION Herein we introduce a novel nomogram that can accurately predict the risk of sCKD-upstaging at 3 years. Based on this nomogram, it is possible to identify four risk categories. If externally validated, this nomogram may represent a useful tool to improve patient counseling and management.
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Affiliation(s)
- Rocco Simone Flammia
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, 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
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Jennifer Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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Licari LC, Bologna E, Franco A, Ditonno F, Manfredi C, Huang J, Latchamsetty K, Coogan C, Olweny EO, Cherullo EE, Chow AK, Vourganti S, Autorino R. Single-port vs multi-port robot-assisted partial nephrectomy: A single center propensity score-matched analysis. Eur J Surg Oncol 2024; 50:108011. [PMID: 38359726 DOI: 10.1016/j.ejso.2024.108011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION AND OBJECTIVES The aim of the study is to compare key outcomes of Single-Port (SP) and Multi-Port (MP) robot-assisted partial nephrectomy (RAPN). METHODS A retrospective analysis was conducted on our prospectively collected database of patients who underwent SP-RAPN or MP-RAPN at our institution from January 2021 to August 2023. To adjust for potential baseline pre-operative confounders, a 1:1 propensity-score matching analysis (PSMa) was performed. The primary endpoint was to compare perioperative outcomes between the two groups. The secondary endpoint was to compare the achievement of the "Trifecta" outcome (defined as negative surgical margins, absence of high-grade complications and change in eGFR values (ΔeGFR) < 10% at 6 months follow-up) in the matched cohort. RESULTS After PSMa, 30 SP cases were matched 1:1 to 30 MP cases. In the matched cohort, there were no significant differences between SP and MP approaches in operative time, estimated blood loss, ischemia time, transfusions rate, intraoperative complications, postoperative complications, and positive surgical margin rates. Patients who underwent SP-RAPN had a shorter median length of stay [25 (IQR:24.0-34.5) vs 34 (IQR:30.2-48.0) hours, p < 0.003]. The Trifecta outcome was achieved in 16 (57%) of SP patients and 17 (63%) of MP patients (p = 0.8). CONCLUSIONS SP-RAPN can be safely implemented in a Center with an established MP-RAPN program. Despite being early in the SP-RAPN experience, key surgical outcomes are not compromised. While offering comparable perioperative and short-term functional outcomes, SP-RAPN can translate into faster recovery and shorter LOS, paving the way for outpatient robotic surgery.
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Affiliation(s)
| | | | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
| | | | | | - Jonathan Huang
- Department of Urology, Rush University, Chicago, IL, USA
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Meneghetti I, Sighinolfi MC, Dibitetto F, Collins JW, Mosillo L, Catalano C, Rocco B, De Dominicis M, De Maria M. Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience. J Robot Surg 2024; 18:73. [PMID: 38349425 DOI: 10.1007/s11701-024-01843-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/21/2024] [Indexed: 02/15/2024]
Abstract
Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.
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Affiliation(s)
| | | | - Francesco Dibitetto
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
| | - Justin W Collins
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
- Division of Uro-oncology, University College London Hospital, London, UK
- CMR Surgical, Cambridge, UK
| | - Luca Mosillo
- Department of Urology, Apuane Hospital, Massa, Italy
| | | | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mauro De Dominicis
- Department of Urology, Uroclinic Casa di Cura Nuova Villa Claudia, Rome, Italy
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Bravi CA, Mottaran A, Sarchi L, Piro A, Paciotti M, Nocera L, Piramide F, Balestrazzi E, Peraire M, Farinha R, Sorce G, Collà-Ruvolo C, Rebuffo S, De Backer P, D'Hondt F, De Groote R, De Naeyer G, Mottrie A. Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center. World J Urol 2023; 41:3737-3744. [PMID: 37917223 DOI: 10.1007/s00345-023-04665-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems. METHODS We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors. RESULTS A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: - 0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3). CONCLUSION We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations-in particular, cost analyses-these results have important implications for patients, surgeons, and healthcare policymakers.
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Affiliation(s)
- Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.
- ORSI Academy, Ghent, Belgium.
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Piramide
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Peraire
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Gabriele Sorce
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Claudia Collà-Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Silvia Rebuffo
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | | | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
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10
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Wei L, Wang C, Fu J, Qiangba T, Zhou X, He P, Li X, Lang L, Li C, Wang Y. Holographic 3D renal segments reconstruction protects renal function by promote choice of selective renal artery clamping during robot-assisted partial nephrectomy. World J Urol 2023; 41:2975-2983. [PMID: 37698633 DOI: 10.1007/s00345-023-04599-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To investigate the impact of selective artery clamping (SAC) and main artery clamping (MAC) during robot-assisted partial nephrectomy (RAPN) on renal function and the influence of holographic three-dimensional (3D) reconstruction of renal segments on the selection between SAC and MAC. METHODS This retrospective observational study included patients who underwent RAPN at First Hospital Affiliated to the Army Medical University between December 2016 and July 2022. According to the clamping methods, the patients were divided into the SAC group and the MAC group. The primary outcome was renal function. RESULTS A total of 422 patients (194 in the SAC group and 228 in the MAC group) were included. The RAPN procedures were all completed successfully. The patients in SAC group had less glomerular filtration rate (GFR) decline in the affected kidney (8.6 ± 7.0 ml/min vs. 18.7 ± 10.9 ml/min, P < 0.001) and minor estimated glomerular filtration rate (eGFR) decrease (4.3 ± 10.5 ml/min vs. 12.6 ± 12.1 ml/min, P < 0.001) than those in MAC group. Among 37 patients with baseline renal insufficiency, the GFR decline of the affected kidney in the SAC subgroup was significantly lower than in the MAC subgroup (5.5 ± 6.5 ml/min vs. 14.3 ± 9.2 ml/min, P = 0.002). The proportion of patients who underwent 3D reconstruction was significant higher in the SAC group than in the MAC group. (65.46% vs. 28.07%, P < 0.001). CONCLUSION The SAC technique during RAPN may serve as a protective measure for renal function, while the implementation of holographic 3D renal segment reconstruction technique may facilitate optimal selection of SAC.
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Affiliation(s)
- Ling Wei
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Cong Wang
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jian Fu
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Tudan Qiangba
- Department of Urology, Tibet CORPS Hospital of Chinese People's Armed Police Forces, Lhasa, 850000, Tibet, China
| | - Xiaozhou Zhou
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Peng He
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xuemei Li
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lang Lang
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Chunxia Li
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongquan Wang
- Department of Urology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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11
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Berry JM, Hill H, Vetter JM, Bhayani SB, Henning GM, Pickersgill NA, Sivaraman A, Figenshau RS, Kim EH. Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023; 17:2149-2155. [PMID: 37256454 PMCID: PMC10230457 DOI: 10.1007/s11701-023-01637-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
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Affiliation(s)
- James M Berry
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
| | - Hayden Hill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Grant M Henning
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Nicholas A Pickersgill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Arjun Sivaraman
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - R Sherburne Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
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12
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Pandolfo SD, Cerrato C, Wu Z, Franco A, Del Giudice F, Sciarra A, Verze P, Lucarelli G, Imbimbo C, Perdonà S, Cherullo EE, Porpiglia F, Derweesh IH, Autorino R. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023; 10:390-406. [PMID: 38024426 PMCID: PMC10659988 DOI: 10.1016/j.ajur.2023.06.001] [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] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Verona, Italy
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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13
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Otsuka A, Fujisawa M, Miyake H. Perioperative outcomes of robot-assisted partial nephrectomy using hinotori versus da Vinci surgical robot system: a propensity score-matched analysis. J Robot Surg 2023; 17:2435-2440. [PMID: 37462888 DOI: 10.1007/s11701-023-01614-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/13/2023] [Indexed: 09/10/2023]
Abstract
The purpose of this study was to evaluate perioperative outcomes of robot-assisted partial nephrectomy (RAPN) using hinotori, a recently developed robot-assisted surgical platform, by comparing them with those using da Vinci. This study included 303 and 40 consecutive patients who underwent RAPN using da Vinci and hinotori, respectively. To adjust potential baseline parameters between da Vinci and hinotori groups, 1:2 propensity score-matching was performed, and perioperative outcomes in these two groups were comprehensively evaluated. Propensity score-matched analysis generated two groups, consisting of 74 and 37 patients undergoing RAPN using da Vinci and hinotori, respectively, and no significant differences in major baseline parameters were noted between the two groups. RAPN could be completed without conversion to nephrectomy or open surgery in all patients. There were no significant differences in major perioperative outcomes between da Vinci and hinotori groups, including the operative time, time using the robotic system and warm ischemia time. No patient in either group was diagnosed with a positive surgical margin or experienced perioperative complications, corresponding to Clavien-Dindo 3 ≤ . There were no significant differences in the achievements of trifecta and margin, ischemia and complications outcomes between the two groups, and changes in the estimated glomerular filtration rate 1 and 28 days after RAPN were also similar between them. In conclusion, these findings showed that the hinotori platform could facilitate similar perioperative outcomes in patients undergoing RAPN in comparison with the existing robotic system, da Vinci.
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Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
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14
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Margue G, Bigot P, Ingels A, Roupret M, Waeckel T, Long JA, Pignot G, Bensalah K, Lang H, Olivier J, Bruyere F, Durand M, Beauval JB, Mallet R, Parier B, De La Taille A, Bernhard JC. Clinical trial protocol for P-NeLoP: a randomized controlled trial comparing the feasibility and outcomes of robot-assisted partial nephrectomy with low insufflation pressure using AirSeal versus standard insufflation pressure (UroCCR no. 85 study). Trials 2023; 24:545. [PMID: 37596613 PMCID: PMC10439590 DOI: 10.1186/s13063-023-07533-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023] Open
Abstract
Robot-assisted partial nephrectomy (RAPN) is the standard of care for small, localized kidney tumors. This surgery is conducted within a short hospital stay and can even be performed as outpatient surgery in selected patients. In order to allow early rehabilitation of patients, an optimal control of postoperative pain is necessary. High-pressure pneumoperitoneum during surgery seems to be the source of significant pain during the first hours postoperatively. Our study is a prospective, randomized, multicenter, controlled study which aims to compare post-operative pain at 24 h between patients undergoing RAPN at low insufflation pressure (7 mmHg) and those operated on at standard pressure (12 mmHg) using the AirSeal system.This trial is registered in the US National Library of Medicine Trial Registry (NCT number: NCT05404685).
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Affiliation(s)
- Gaelle Margue
- Urology Department, Bordeaux University Hospital, Bordeaux, France.
| | - Pierre Bigot
- Urology Department, Angers University Hospital, Angers, France
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | | | | | | | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | | | - Richard Mallet
- Urology Department, Polyclinique Francheville, Perigueux, France
| | - Bastien Parier
- Urology Department, Kremlin Bicetre, APHP, Paris, France
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15
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Yazaki H, Ieda T, China T, Shimizu F, Isotani S, Horie S. Robot-assisted partial nephrectomy for T1b renal cell carcinoma with complete situs inversus totalis with pre- and intraoperative three-dimensional virtual imaging. Urol Case Rep 2023; 49:102413. [PMID: 37228258 PMCID: PMC10205431 DOI: 10.1016/j.eucr.2023.102413] [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] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/27/2023] Open
Abstract
Complete Situs Inversus Totalis (SIT) is a rare congenital anomaly characterized by the transposition of organs to a totally inverted position. We present a case of Robot-Assisted Partial Nephrectomy (RAPN) for T1b renal hilum tumor (RENAL score 9) with SIT. All procedures were performed safely using preoperative three-dimensional (3D) virtual image assistance. There were no intraoperative complications, and the patient was discharged uneventfully. Pathological diagnosis confirmed papillary renal cell carcinoma type1. In patients who have renal cancer with SIT, RAPN can be performed safely, and 3D virtual imaging could provide successful surgical outcomes.
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Affiliation(s)
| | | | | | | | - Shuji Isotani
- Corresponding author. Department of Urology, Juntendo University, Graduate School of Medicine, 113-8421, Hongo 2-1-1, Bunkyo-ku, Tokyo, Japan.
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16
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Umemoto T, Hasegawa M, Yuzuriha S, Kano T, Ogawa T, Kawakami M, Nakano M, Kim H, Nitta M, Kawamura Y, Shoji S, Mizuno R, Miyajima A. Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis. BMC Urol 2023; 23:85. [PMID: 37158841 PMCID: PMC10165753 DOI: 10.1186/s12894-023-01247-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, in this study, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry. METHODS Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (1-2) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm [2]; C2, ≥ 10 and < 15 cm [2]; and C3: ≥ 15 cm [2]. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model. RESULTS Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160-8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor. CONCLUSIONS The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.
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Affiliation(s)
- Tatsuya Umemoto
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan.
| | - Soichiro Yuzuriha
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Tatsuo Kano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Takahiro Ogawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Masayoshi Kawakami
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Mayura Nakano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Hakushi Kim
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Yoshiaki Kawamura
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan
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Bravi CA, Rosiello G, Mazzone E, Minervini A, Mari A, Di Maida F, Bensalah K, Peyronnet B, Khene ZE, Schiavina R, Bianchi L, Mottrie A, De Naeyer G, Antonelli A, Furlan M, Rha KH, Almujalhem A, Derweesh I, Bradshaw A, Kaouk J, Sawczyn G, Bertolo R, Breda A, Montorsi F, Capitanio U, Larcher A. The IRON Study: Investigation of Robot-assisted Versus Open Nephron-sparing Surgery. EUR UROL SUPPL 2023; 49:71-77. [PMID: 36874602 PMCID: PMC9974968 DOI: 10.1016/j.euros.2022.12.017] [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: 12/08/2022] [Indexed: 02/03/2023] Open
Abstract
Background Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce. Objective To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN. Design setting and participants This study included 3467 patients treated with OPN (n = 1063) or RAPN (n = 2404) for a single cT1-2N0M0 renal mass from 2004 to 2018 at nine high-volume European, North American, and Asian institutions. Outcome measurements and statistical analysis The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN. Results and limitations Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both p < 0.05). This association was not affected by comorbidities, tumor dimension, PADUA score, or preoperative renal function (all p > 0.05 on interaction tests). On multivariable analyses, we found no differences between the two techniques with respect to functional and oncologic outcomes (all p > 0.05). Overall, there were 63 and 92 local recurrences and systemic progressions, respectively, with a median follow-up after surgery of 32 mo (interquartile range: 18, 60). Among patients receiving RAPN, we assessed predictors of local recurrence and systemic progression with discrimination accuracy (ie, C-index) that ranged from 0.73 to 0.81. Conclusions While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery. Patient summary In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.
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Affiliation(s)
- Carlo Andrea Bravi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Giuseppe Rosiello
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Maria Furlan
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Koon Ho Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahmad Almujalhem
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ithaar Derweesh
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Aaronw Bradshaw
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Jihak Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Corresponding author. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy. Tel. +39 02.2643.7286.
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Gallioli A, Uleri A, Gaya JM, Territo A, Aumatell J, Verri P, Basile G, Fontanet S, Tedde A, Diana P, Suquilanda E, Algaba F, Palou J, Breda A. Initial experience of robot-assisted partial nephrectomy with Hugo™ RAS system: implications for surgical setting. World J Urol 2023; 41:1085-1091. [PMID: 36847815 DOI: 10.1007/s00345-023-04336-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
PURPOSE Hugo™ RAS system is one of the most promising new robotic platforms introduced in the field of urology. To date, no data have been provided on robot-assisted partial nephrectomy (RAPN) performed with Hugo™ RAS system. The aim of the study is to describe the setting and report the performance of the first series of RAPN performed with Hugo™ RAS system. METHODS Ten consecutive patients who underwent RAPN at our Institution between February and December 2022 were prospectively enrolled. All RAPN were performed transperitoneally with a modular four-arm configuration. The main outcome was to describe the operative room setting, trocar placement and the performance of this novel robotic platform. Pre, intra and post-operative, variables were recorded. A descriptive analysis was performed. RESULTS Seven patients underwent RAPN for right-side and three for left-side masses. Median tumor size and PADUA score were 3 (2.2-3.7) cm and 9 (8-9), respectively. Median docking and console time were 9.5 (9-14) and 138 (124-162) minutes, respectively. Median warm ischemia time was 13 (10-14) minutes, and one case was performed clamp-less. Median estimated blood loss was 90 (75-100) mL. One major complication (Clavien-Dindo 3a) occurred. No case of positive surgical margin was recorded. CONCLUSION This is the first series to prove the feasibility of Hugo™ RAS system in the setting of RAPN. These preliminary results may help new adopters of this surgical platform to identify critical steps of robotic surgery with this platform and explore solutions before in-vivo surgery.
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Affiliation(s)
- Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain.
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Julia Aumatell
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Sofia Fontanet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Alessandro Tedde
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Edgar Suquilanda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Carrer de Cartagena, 350, 08025, Barcelona, Spain
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Nakanishi Y, Hirose K, Yasujima R, Umino Y, Okubo N, Kataoka M, Yajima S, Masuda H. Impact of perinephric fat volume and the Mayo Adhesive Probability score on time to clamping in robot-assisted partial nephrectomy. J Robot Surg 2023:10.1007/s11701-023-01544-8. [PMID: 36788149 DOI: 10.1007/s11701-023-01544-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
The aim of this study is to evaluate the association of perinephric fat volume (PNFV) and the Mayo Adhesive Probability (MAP) score with time to clamping (TTC) in robot-assisted partial nephrectomy (RAPN). The study subjects consisted of 73 tumors in 72 patients who underwent transperitoneal RAPN at a single cancer center between February 2020 and July 2022. Clinical characteristics including R.E.N.A.L. nephrometry score, MAP score and PNFV were evaluated in a multivariate analysis in relation to TTC, which was classified into two groups based on median TTC. PNFV and MAP score were analyzed separately. PNFVs were measured by SYNAPSE VINCENT® by a single expert urologist. Median TTC was 67 (range: 36-119) min. Spearman's rank correlation analysis indicated that a significant correlation was observed between PNFV and MAP score with a value of 0.81 (p < 0.0001). Univariate analysis revealed that R.E.N.A.L. nephrometry score ≥ 7 (p = 0.036), posterior tumor location (p = 0.033), MAP score ≥ 3 (p = 0.02) and PNFV ≥ 250 ml (p = 0.02) were significant factors for prolonged TTC. In a multivariate analysis including PNFV (analysis 1), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and PNFV ≥ 250cm3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Similarly for MAP score (analysis 2), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and MAP score ≥ 3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Both MAP score and PNFV may have a significant impact on TTC.
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Affiliation(s)
- Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
| | - Kohei Hirose
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Rikuto Yasujima
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Yosuke Umino
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Naoya Okubo
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
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Bernhard JC, Robert G, Ricard S, Rogier J, Degryse C, Michiels C, Margue G, Blanc P, Alezra E, Estrade V, Capon G, Bladou F, Ferriere JM. Nurse-led coordinated surgical care pathways for cost optimization of robotic-assisted partial nephrectomy: medico-economic analysis of the UroCCR-25 AMBU-REIN study. World J Urol 2023; 41:325-333. [PMID: 35727334 DOI: 10.1007/s00345-022-04066-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Robot-assisted partial nephrectomy (RAPN) reduces morbidity, enabling development of Enhanced Recovery After Surgery (ERAS) and day-case protocols. Additional financial costs limit its integration into clinical practice. We evaluated the medico-economic impact of RAPN using a nurse-led coordinated pathway of care (NLC-RAPN). METHODS All tumor RAPNs performed in 2017 were prospectively included in nurse-led protocols: NP-RAAC (ERAS) or Ambu-Rein (day case). Clinico-biological and pathological data were prospectively collected within the French Research Network for Kidney Cancer database (NCT03293563). Estimated costs were compared to "average" patients at the national level operated by open partial nephrectomy (OPN) or RAPN, using data from the 2017 French hospital discharge database and the national cost scale. RESULTS The NLC-RAPN cohort (n = 151) included 27 (18%) outpatients and the average hospital length of stay (LOS) was 2.4 days. In the national control cohorts for OPN (n = 2475) and RAPN (n = 3529), the average LOS were 8.0 and 5.2 days, respectively. The mean incomes per group were €7607 for NLC-RAPN, €9813 for OPN, and €8215 for RAPN. The mean daily cost of stay was €659 for NLC-RAPN, €838 for OPN, and €725 for RAPN. The overall cost for NLC-RAPN was €6594, €8733 for OPN, and €8763 for RAPN. The best operational margin was obtained for day-case NLC-RAPN (€1967). CONCLUSION Combining RAPN with nurse-led coordinated pathways of care led to a shorter hospital stay and reduced costs versus OPN. This may facilitate the economic sustainability of robotic assistance for hospitals where the extra cost is not covered by the healthcare system.
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Affiliation(s)
- Jean-Christophe Bernhard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France.
| | - Grégoire Robert
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Solène Ricard
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
- UroCCR, French Research Network On Kidney Cancer, Bordeaux, France
| | - Julien Rogier
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Cécile Degryse
- Department of Anesthesiology, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Peggy Blanc
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Université de Bordeaux, CHU de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
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21
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Pandolfo SD, Loizzo D, Beksac AT, Derweesh I, Celia A, Bianchi L, Elbich J, Costa G, Carbonara U, Lucarelli G, Cerrato C, Meagher M, Ditonno P, Hampton LJ, Basile G, Kim FJ, Schiavina R, Capitanio U, Kaouk J, Autorino R. Percutaneous thermal ablation for cT1 renal mass in solitary kidney: A multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy. Eur J Surg Oncol 2023; 49:486-490. [PMID: 36216659 DOI: 10.1016/j.ejso.2022.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Renal cell carcinoma (RCC) in solitary kidney (SK) represents a challenging scenario. We sought to compare outcomes of robot-assisted partial nephrectomy (RAPN) versus percutaneous thermal ablation (PTA) in SK patients with renal tumors cT1. MATERIALS AND METHODS We performed a multicenter retrospective analysis of SK patients treated for RCC. The PTA group included cryoablation or radiofrequency ablation. We collected baseline characteristics, intraoperative, pathological, and post-operative data. We applied an arbitrary composite "trifecta" to assess surgical, functional, and oncological outcomes, only for malignant histology. RFS analysis was performed using the Kaplan-Meier method. Multivariable regression analysis was performed to determine independent predictors of "trifecta" achievement. RESULTS We included 198 SK patients (RAPN, n = 50; PTA n = 119). Mean clinical tumor size was not significantly different while R.E.N.A.L. score was higher for RAPN (p < 0.001). No differences in intra and major post-procedural complications. Recurrence rate was higher in PTA group but not statistically significant (p < 0.328). No difference in metastasis rate was found (p = 0.435). RFS was 96.1% in RAPN and 86.8% in PTA cohort (p = 0.003) while no difference in PFS was detected (p = 0.1). Trifecta was achieved in 72.5% of RAPN vs 77.3% of PTA (p = 0.481). Multivariable analysis has not detected predictors for Trifecta achievement. CONCLUSION PTA offers good outcomes in the management of SK patients with RCC. Compared with RAPN, it might carry a higher risk of recurrence; on the other hand, re-treatment is possible. Overall, PTA can be safely offered to treat SK patients presenting RCC. In general, it should be preferred in more frail patients to minimize the risk of complications.
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Affiliation(s)
- Savio Domenico Pandolfo
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Napoli, Italy.
| | - Davide Loizzo
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Antonio Celia
- Department of Urology, San Bassano Hospital, Bassano Del Grappa, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jeffrey Elbich
- Department of Radiology, Vascular Interventional Radiology, VCU Health, Richmond, VA, USA
| | - Giovanni Costa
- Department of Urology, San Bassano Hospital, Bassano Del Grappa, Italy
| | - Umberto Carbonara
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Clara Cerrato
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Margaret Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Lance J Hampton
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
| | - Giuseppe Basile
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Division of Urology & Massey Cancer Center, VCU Health, Richmond, VA, USA
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Farinha R, Breda A, Porter J, Mottrie A, Van Cleynenbreugel B, Vander Sloten J, Mottaran A, Gallagher AG. Objective assessment of intraoperative skills for robot-assisted partial nephrectomy (RAPN). J Robot Surg 2023:10.1007/s11701-023-01521-1. [PMID: 36689078 PMCID: PMC10374474 DOI: 10.1007/s11701-023-01521-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
RAPN training usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee capacity to perform RAPN at predetermined performance levels prior to in-vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes. The authors sought to examine the reliability, construct and discriminative validity of objective intraoperative performance metrics which best characterize the optimal and suboptimal performance of a reference approach for training novice RAPN surgeons. Seven Novice and 9 Experienced RAPN surgeons video recorded one or two independently performed RAPN procedures in the human. The videos were anonymized and two experienced urology surgeons were trained to reliably score RAPN performance, using previously developed metrics. The assessors were blinded to the performing surgeon, hospital and surgeon group. They independently scored surgeon RAPN performance. Novice and Experienced group performance scores were compared for procedure steps completed and errors made. Each group was divided at the median for Total Errors score, and subgroup scores (i.e., Novice HiErrs and LoErrs, Experienced HiErrs and LoErrs) were compared. The mean inter-rater reliability (IRR) for scoring was 0.95 (range 0.84-1). Compared with Novices, Experienced RAPN surgeons made 69% fewer procedural Total Errors. This difference was accentuated when the LoErr Expert RAPN surgeon's performance was compared with the HiErrs Novice RAPN surgeon's performance with an observed 170% fewer Total Errors. GEARS showed poor reliability (Mean IRR = 0.44; range 0.0-0.8), for scoring RAPN surgical performance. The RAPN procedure metrics reliably distinguish Novice and Experienced surgeon performances. They further differentiated performance levels within a group with similar experiences. Reliable and valid metrics will underpin quality-assured novice RAPN surgical training.
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Affiliation(s)
- Rui Farinha
- Orsi Academy, Proefhoevestraat 12, Melle, 9090, Ghent, Belgium.
- Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
- Department of Urology, São José Hospital, Lisbon, Portugal.
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - James Porter
- Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA
| | - Alexandre Mottrie
- Orsi Academy, Proefhoevestraat 12, Melle, 9090, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Jozef Vander Sloten
- Department of Mechanical Engineering, Section of Biomechanics, KU Leuven, Louvain, Belgium
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaris di Bologna, Bologna, Italy
- University of Bologna, Bologna, Italy
| | - Anthony G Gallagher
- Orsi Academy, Proefhoevestraat 12, Melle, 9090, Ghent, Belgium
- Faculty of Medicine, KU Leuven, Louvain, Belgium
- Faculty of Life and Health Sciences, Ulster University, Derry, Northern Ireland, UK
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Lyu X, Jia Z, Ao L, Ren C, Wu Y, Xu Y, Chen K, Gao Y, Wang B, Ma X, Zhang X. Robot-assisted partial nephrectomy: Can retroperitoneal approach suit for renal tumors of all locations?-A large retrospective cohort study. BMC Urol 2022; 22:202. [PMID: 36496356 PMCID: PMC9741774 DOI: 10.1186/s12894-022-01128-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to explore the appropriate location of renal tumors for retroperitoneal approach. MATERIALS AND METHODS We retrospectively analyzed 1040 patients with renal tumor who were treated at our institution from Janurary 2015 to June 2020 and had underwent retroperitoneal robotic assisted-laparoscopic partial nephrectomy (rRAPN). Clinical features and postoperative outcomes were evaluated. RESULTS Patients with incomplete data were excluded, and we included 896 patients in total. The median tumor size was 3.0 (range: 0.8-10.0) cm. The median RENAL Nephrometry Score was 7 (range: 4-11), and the median PADUA Nephrometry Score was 8 (range: 6-14). The median surgical time was 120 min, and the median warm ischemia time was 18 min. The median estimated blood loss was 50 ml. The follow-up time was 20.2 (range: 12-69) months. The mean change of eGFR 1 year after operation was 14.6% ± 19.0% compared with preoperative estimated glomerular filtration rate (eGFR). When compared the tumor at different locations, as superior or inferior pole, anterior of posterior face of kidney, there were no significant differences of intra- and post-operative outcomes such as surgical time, warm ischemia time, estimated blood loss, removal time of drainage tube and catheter, postoperative feeding time and hospital stay, and changes of eGFR one year after surgery. We also compared tumors at special locations as endophytic or exophytic, anterior of posterior hilus of kidney, there were no significant differences in surgical time, warm ischemia time, estimated blood loss and changes of eGFR. There was no significant difference in intraoperative features and postoperative outcomes when tumor larger than 4 cm was located at different positions of kidney. Though the surgical time was longer when BMI ≥ 28 (132.6 min vs. 122.5 min, p = 0.004), no significant differences were observed in warm ischemia time, estimated blood loss, changes in eGFR. Twenty-seven patients (3.0%) had tumor progression, including 8 (0.9%) recurrence, 19 (2.1%) metastasis, and 9 (1.0%) death. CONCLUSION Retroperitoneal approach for RAPN has confirmed acceptable intra- and postoperative outcomes and suits for renal tumors of all different locations. Large tumor size and obesity are not contraindications for rRAPN.
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Affiliation(s)
- Xiangjun Lyu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Zhuo Jia
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Liyan Ao
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Changhao Ren
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yangyang Wu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yunlai Xu
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Ke Chen
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Yu Gao
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Baojun Wang
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Xin Ma
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
| | - Xu Zhang
- grid.414252.40000 0004 1761 8894Department of Urology, The Third Medical Center, Chinese PLA General Hospital, 28 Fu Xing Road, Haidian District, Beijing, 100853 China
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24
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Harke NN, Kuczyk MA, Huusmann S, Schiefelbein F, Schneller A, Schoen G, Wiesinger C, Pfuner J, Ubrig B, Gloger S, Osmonov D, Eraky A, Witt JH, Liakos N, Wagner C, Hadaschik BA, Radtke JP, Al Nader M, Imkamp F, Siemer S, Stöckle M, Zeuschner P. Impact of Surgical Experience Before Robot-assisted Partial Nephrectomy on Surgical Outcomes: A Multicenter Analysis of 2500 Patients. EUR UROL SUPPL 2022; 46:45-52. [PMID: 36506259 PMCID: PMC9732453 DOI: 10.1016/j.euros.2022.10.003] [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: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) is a challenging procedure that is influenced by a multitude of factors. Objective To assess the impact of prior surgical experience on perioperative outcomes in RAPN. Design setting and participants In this retrospective multicenter study, results for 2548 RAPNs performed by 25 surgeons at eight robotic referral centers were analyzed. Perioperative data for all consecutive RAPNs from the start of each individual surgeon's experience were collected, as well as the number of prior open or laparoscopic kidney surgeries, pelvic surgeries (open, laparoscopic, robotic), and other robotic interventions. Intervention Transperitoneal or retroperitoneal RAPN. Outcome measurements and statistical analysis The impact of prior surgical experience on operative time, warm ischemia time (WIT), major complications, and margin, ischemia, complication (MIC) score (negative surgical margins, WIT ≤20 min, no major complications) was assessed via univariate and multivariable regression analyses accounting for age, gender, body mass index (BMI), American Society of Anesthesiologists score, PADUA score, and RAPN experience. Results and limitations BMI, PADUA score, and surgical experience in RAPN had a strong impact on perioperative outcomes. A plateau effect for the learning curve was not observed. Prior laparoscopic kidney surgery significantly reduced the operative time (p < 0.001) and WIT (p < 0.001) and improved the MIC rate (p = 0.022). A greater number of prior robotic pelvic interventions decreased WIT (p = 0.011) and the rate of major complications (p < 0.001) and increased the MIC rate (p = 0.011), while prior experience in open kidney surgery did not. One limitation is the short-term follow-up. Conclusions Mastering of RAPN is an ongoing learning process. However, prior experience in laparoscopic kidney and robot-assisted pelvic surgery seems to improve perioperative outcomes for surgeons when starting with RAPN, while experience in open surgery might not be crucial. Patient summary In this multicenter analysis, we found that a high degree of experience in keyhole kidney surgery and robot-assisted pelvic surgery helps surgeons in achieving good initial outcomes when starting robot-assisted kidney surgery.
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Affiliation(s)
- Nina N. Harke
- Department of Urology, Hannover Medical School, Hannover, Germany,Corresponding author. Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Tel. +49 511 532 5847; Fax +49 511 532 5634.
| | - Markus A. Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Stephan Huusmann
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Frank Schiefelbein
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Andreas Schneller
- Department of Urology, Klinikum Wuerzburg Mitte-Missioklinik, Wuerzburg, Germany
| | - Georg Schoen
- Department of Urology, Urologische Klinik Muenchen-Planegg, Planegg, Germany
| | - Clemens Wiesinger
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Jacob Pfuner
- Department of Urology, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Simon Gloger
- Department of Urology, Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - Daniar Osmonov
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ahmed Eraky
- Department of Urology, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jörn H. Witt
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Christian Wagner
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | | | | | - Mulham Al Nader
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Florian Imkamp
- Department of Urology, Vinzenzkrankenhaus Hannover, Hannover, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
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Imada H, Akita T, Sugiyama A, Tanaka J. Impact of robot-assisted surgery appearance on reduction of annual blood transfusion cases in Japan: application of meta-analysis and NDB open data. J Robot Surg 2022; 16:1229-1232. [PMID: 34997909 PMCID: PMC8742561 DOI: 10.1007/s11701-021-01365-7] [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] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
In Japan, the robot-assisted partial nephrectomy (RAPN) started to be covered by health insurance since 2016, and it is replacing conventional open partial nephrectomy (OPN). RAPN is a minimally invasive surgery, and the spreading of RAPN in partial nephrectomy (PN) performed annually is expected to reduce the number of blood transfusions in Japan. The number of PN surgery in Japan was calculated using the Japanese NDB open data in 2018. We extracted articles comparing the transfusion rates of RAPN and OPN from 2017 to 2021 using PubMed, Web of Science, and Ichu-shi, and integrated the ratios of transfusion rates by meta-analysis. We estimated the reduction in the annual transfusion cases in PN due to the widespread use of RAPN. The total number of renal cancer surgeries in 2018 was 21,298, of which 3,876 (18.2%) were RAPN and 4,384 (20.6%) were OPN. For the comparison of transfusion implementation rate between RAPN and OPN, 871 articles were screened and 27 articles were included. The pooled ratio in transfusion rate of RAPN compared with OPN was 0.49 [0.46, 0.52]; the introduction of RAPN was estimated to have reduced the annual number of transfusions in PN by 9.1% compared with that of unintroduced RAPN. This study showed quantitatively evaluated the impact of the introduction of RAPN on the decrease in the annual number of transfusions in Japan. This method has the potential to evaluate the impact of robot-assisted surgery on the use of blood products for transfusion.
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Affiliation(s)
- Hirohito Imada
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Bianchi L, Schiavina R, Bortolani B, Cercenelli L, Gaudiano C, Mottaran A, Droghetti M, Chessa F, Boschi S, Molinaroli E, Balestrazzi E, Costa F, Rustici A, Carpani G, Piazza P, Cappelli A, Bertaccini A, Golfieri R, Marcelli E, Brunocilla E. Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor's Anatomy in Patients with Renal Cancer. Eur Urol Focus 2022; 8:1300-1308. [PMID: 34429273 DOI: 10.1016/j.euf.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Three-dimensional (3D) models improve the comprehension of renal anatomy. OBJECTIVE To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor's blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor's sphericity); ConvT (tumor's convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). INTERVENTION RAPN with a 3D model. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. RESULTS AND LIMITATIONS Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. CONCLUSIONS Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. PATIENT SUMMARY Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy.
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Barbara Bortolani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Caterian Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Sara Boschi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Arianna Rustici
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Carpani
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
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Hatayama T, Tasaka R, Mochizuki H, Mita K. Comparison of surgical outcomes and split renal function between laparoscopic and robot-assisted partial nephrectomy: a propensity score-matched analysis. Int Urol Nephrol 2022; 54:805-811. [PMID: 35178639 DOI: 10.1007/s11255-022-03144-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The objective of this study was to compare perioperative outcomes and total and split renal function between laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN). Predictive risk factors of preservation of operated renal function were also assessed. METHODS We retrospectively analyzed 173 patients who underwent LPN (n = 84) or RAPN (n = 89) between 2010 and 2020. After propensity score matching (1:1), perioperative outcomes and total and split renal function were assessed. Logistic regression analysis was used to evaluate predictive risk factors of preservation of operated renal function. Trifecta criteria were defined as negative surgical margins, warm ischemia time (WIT) < 25 min, and no complications more than Clavien-Dindo grade II within 4 weeks after surgery. Split renal function was evaluated by mercaptoacetyltriglycine renal scan. RESULTS After propensity score matching, 42 patients were allocated to each group. RAPN was associated with significantly shorter WIT (RAPN vs LPN: 12 vs 22 min; p < 0.0001) and higher trifecta achievement rate (93.3 vs 64.2%; p < 0.0001). Other perioperative outcomes and total and split renal function were not significantly different between LPN and RAPN. The R.E.N.A.L. nephrometry score (RNS) was a predictive risk factor of preservation of operated renal function in the multivariable logistic regression analysis (odds ratio 1.68, 95% confidence interval 1.29-2.20, p < 0.0001). CONCLUSIONS RAPN improved WIT and trifecta achievement rate, but it did not improve the preservation of operated renal function, for which RNS was found to be a strong predictive risk factor.
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Affiliation(s)
- Tomoya Hatayama
- Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Ryo Tasaka
- Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Hideki Mochizuki
- Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Koji Mita
- Department of Urology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asakita-ku, Hiroshima, 731-0293, Japan.
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Nohara T, Kadomoto S, Iwamoto H, Yaegashi H, Iijima M, Kawaguchi S, Shima T, Shigehara K, Izumi K, Kadono Y, Seto C, Mizokami A. Test clamp procedure in robot-assisted partial nephrectomy: is it a safe procedure? J Robot Surg 2021; 16:633-639. [PMID: 34313949 DOI: 10.1007/s11701-021-01288-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
We performed test clamp procedure in robot-assisted partial nephrectomy (RAPN) to prevent massive bleeding during tumor resection and to omit dissection of non-feeding arteries around the tumor. We subsequently analyzed the safety and usefulness of the procedure. The Test clamp procedure was performed for 1 to 3 min during renal artery test ischemia prior to the actual ischemia and tumor resection. We confirmed the disappearance of blood flow around the renal tumor using color Doppler ultrasonography. If arterial blood flow around the tumor remained, we surveyed the site for other arteries that needed to be clamped and repeated the test clamp procedure until renal blood flow around the tumor disappeared. We retrospectively analyzed consecutive RAPN cases performed from July 2016 to March 2020 at our institutions and reviewed medical records. The clinical data of the RAPN cases were statistically analyzed. Sixty-four RAPN cases underwent the test clamp procedure, which was categorized as the TEST group. Test clamping was performed safely without any clamping-related complications in all cases. Eleven cases (17%) underwent partial ischemia, which was a significantly higher number than that in the control group. Massive bleeding during tumor resection was more frequent in the control group. Postoperative deterioration of estimated glomerular filtration rate did not differ significantly between both groups. Although further investigation was still necessary, our findings indicate that the test clamp procedure may be a safe and secure procedure to perform in RAPN for both patients and surgeons.
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Affiliation(s)
- Takahiro Nohara
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan. .,Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan.
| | - Suguru Kadomoto
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroaki Iwamoto
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroshi Yaegashi
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Masashi Iijima
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shohei Kawaguchi
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takashi Shima
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Kazuyoshi Shigehara
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kouji Izumi
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yoshifumi Kadono
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Chikashi Seto
- Department of Urology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Atsushi Mizokami
- Department of Urology, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan
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Carbonara U, Eun D, Derweesh I, Capitanio U, Celia A, Fiori C, Checcucci E, Amparore D, Lee J, Larcher A, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Montorsi F, Porpiglia F, Autorino R. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 2021; 39:4175-4182. [PMID: 34050813 DOI: 10.1007/s00345-021-03741-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared. RESULTS Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7). CONCLUSION r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Devin Patel
- Department of Urology, UCSD, San Diego, CA, USA
| | | | | | | | - Lance J Hampton
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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30
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Diana P, Lughezzani G, Uleri A, Casale P, Saita A, Hurle R, Lazzeri M, Mottrie A, De Naeyer G, De Groote R, Porter J, Buffi N. Multi-institutional Retrospective Validation and Comparison of the Simplified PADUA REnal Nephrometry System for the Prediction of Surgical Success of Robot-assisted Partial Nephrectomy. Eur Urol Focus 2020; 7:1100-1106. [PMID: 33272907 DOI: 10.1016/j.euf.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The use of a nephron-sparing surgery for the treatment of localized renal masses is being pushed to more challenging cases. However, this procedure is not devoid of risks, and the Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classifications are commonly employed in the prediction of complications. Recently, the Simplified PADUA REnal (SPARE) scoring system has been proposed with the aim to provide a more simple system, to improve its reproducibility to predict postoperative risks. OBJECTIVE We aim to retrospectively validate and compare the proposed new SPARE system in a multi-institutional population. DESIGN, SETTING, AND PARTICIPANTS The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group collected data from 737 patients subjected to robot-assisted partial nephrectomy (RAPN) between 2010 and 2016 at three tertiary care referral centers. Of these patients, 536 presented complete demographic and clinical data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Renal masses were classified according to the SPARE, RENAL, and PADUA nephrometry scores, and surgical success was defined according to the margin, ischemia, and complication scores. RESULTS AND LIMITATIONS Of 536 patients, 340 were male; the median age was 61 (53-69) yr and preoperative tumor size was 30 (22-43) mm. The margin, ischemia, and complication score was achieved in 399 of cases (74.4%). All three nephrometry scores were significant predictors of surgical outcomes both in univariate and in adjusted multivariate logistic regression model analysis. In accuracy analysis, the area under the curve (AUC) of the SPARE scoring system (0.73) was significantly higher than those of the PADUA (0.65) and RENAL (0.68) nephrometry scores in predicting surgical success. CONCLUSIONS The SPARE score appears to be a promising and reliable score for the prediction of surgical outcomes of RAPN, showing a higher accuracy relative to the traditional PADUA and RENAL nephrometry scores. Further, prospective studies are warranted before its introduction in clinical practice. PATIENT SUMMARY The Simplified PADUA REnal (SPARE) score is a reproducible and simple nephrometry score, offering better predictive capabilities of surgical success and complications.
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Affiliation(s)
- Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessandro Uleri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Nicolomaria Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Gontero P, Mari A, Marra G, Nazzani S, Allasia M, Antonelli A, Barale M, Brunocilla E, Capitanio U, Di Maida F, Gallioli A, Longo N, Montorsi F, Porpiglia F, Porreca A, Rocco B, Simeone C, Schiavina R, Tellini R, Terrone C, Villari D, Ficarra V, Carini M, Minervini A. Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study. Urol Oncol 2021; 39:78.e17-26. [PMID: 33127300 DOI: 10.1016/j.urolonc.2020.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND To investigate the perioperative and morbidity outcomes after partial nephrectomy (PN) in patients with short life expectancy (SLE) (≥95% 10-year expected mortality (10y-EM)), to assess the main predictors of outcomes in this population and to compare these results with those of a group at the opposite upper range with long LE (LLE, ≤5% 10y-EM) relying on a multicenter Italian prospective registry of kidney surgery (the RECORD 2 project). METHODS Clinical data of 4,325 patients undergone kidney surgery were collected at 26 urological Italian Centers from 2013 to 2016. SLE was defined as a ≥95% 10y-EM (assessed using the age-adjusted Charlson comorbidity index [CCI]). A multivariable logistic regression for overall postoperative complications, acute kidney injury (AKI), positive surgical margins (SM) and ∆ estimated glomerular filtration rate (eGFR) ≥25% at 2 years from surgery was performed in patients with SLE including clinically relevant variables. Adjusted outcomes reported as mean (SD) of the 2 groups were generated using separate multivariable logistic regression models and compared. RESULTS Overall, 559 patients with SLE were selected. Patients had an ASA score ≥3 in 58.4% of cases. A clinical T1a, T1b, and T2 stage was found in 412 (74.5%), 124 (22.4%), and 17 (3.1%) patients. The median PADUA score was 7 (6-8). Surgical and medical postoperative complication rates were registered in 14.8% and 6% cases. Postoperative AKI was reported in 27.3% cases, positive surgical margins (PSM) in 9.3% cases. In this subgroup of patients, ASA score, cerebrovascular disease, surgery in low volume centers, and open surgery were independent predictors of overall complications. ASA and PADUA scores, renal clamping, resection technique and lower eGFR at baseline were independent predictors of AKI. PADUA score, open approach and resection technique were independent predictors of PSM. Cardiovascular disease, hilar clamping, and resection technique were independent predictors of eGFR decrease >25% at 2 years from surgery. Patients with SLE were compared with those with LLE (n = 302). All analyzed parameters at baseline were significantly different among the groups with the exception of cancer laterality. After adjusting for several clinical variables, the SLE group had a significantly higher risk rate of adjusted overall postoperative complication rate compared to the LLE group (20.6% ± 0.36 vs. 9.9% ± 0.65, P < 0.0001), while the overall intraoperative complications (4.1% ±0.13 vs. 2.3% ± 0.23), overall postoperative major complications (3.8% ± 0.09 vs. 1.9% ± 0.14) adjusted AKI (24.2% ± 0.37 vs. 22.6% ± 0.92), positive surgical margins (8% ± 0.22 vs. 6.4% ± 0.49), and 2-year RF loss (13.4% ± 0.17 vs. 12.4% ± 0.74). CONCLUSION In selected patients with SLE, PN is feasible with an acceptable safety profile that is overall comparable to patients with no LE limitations. While a robotic approach and surgery performed in high volume centers could reduce the risk of complications, an off-clamp approach and a SE surgical technique may decrease the risk of postoperative AKI and of longer term eGFR decrease.
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Sri D, Thakkar R, Patel HRH, Lazarus J, Berger F, McArthur R, Lavigueur-Blouin H, Afshar M, Fraser-Taylor C, Le Roux P, Liban J, Anderson CJ. Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the "Trifecta and Pentafecta". J Robot Surg 2020; 15:571-577. [PMID: 32885379 PMCID: PMC8295154 DOI: 10.1007/s11701-020-01141-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/05/2020] [Accepted: 08/17/2020] [Indexed: 12/29/2022]
Abstract
Partial nephrectomy (PN) for small renal masses is common, but outcomes are not reported in a standard manner. Traditionally, parameters such as 90-day mortality, blood loss, transfusion rates, length of stay, nephrometry scoring and complications are published but their collective impact on warm ischemia time (WIT) and post-surgery GFR is rarely determined. Thus, our aim was to assess if “Trifecta” and “Pentafecta” outcomes could be used as useful surgical outcome markers. A prospective database of 252 Robotic-Assisted PN (RAPN) cases (2008–2019) was analysed. “Pentafecta” was defined as achievement of “Trifecta” (negative surgical margin, no postoperative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Binary logistic regression analysis was conducted to predict factors which may prevent achieving a Trifecta/Pentafecta. Median tumour size was 3 cm and mean WIT was 15 min. Positive surgical margins (PSM) occurred in 2 cases. Overall, the intra-operative complication rate was 7%. One recurrence conferred 5-year cancer-free survival of 97%. Trifecta outcome was achieved in 169 (67%) and Pentafecta in 141 (56%) of cases. At logistic regression analysis, intraoperative blood loss was the only factor to affect Trifecta achievement (p = 0.018). Advanced patient age negatively impacted Pentafecta achievement (p = 0.010). The Trifecta and Pentafecta outcomes are easily applicable to PN data, and offer an internationally comparable PN outcome, quality measure. We recommend applying this standardization to national data collection to improve the quality of reporting and ease of interpretation of surgeon/centres’ outcomes.
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Affiliation(s)
- D Sri
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK.
| | - R Thakkar
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - H R H Patel
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - J Lazarus
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - F Berger
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - R McArthur
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | | | - M Afshar
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - C Fraser-Taylor
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - P Le Roux
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - J Liban
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
| | - C J Anderson
- St George's Hospital NHS Trust, Tooting, London, SW17 0QT, UK
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Tanaka N, Kitazawa T, Mitani S, Suzuka T, Kadoya Y, Kawaguchi M. Anesthetic management using a combination of anterior quadratus lumborum block and erector spinae plane block for robot-assisted partial nephrectomy: two case reports. JA Clin Rep 2020; 6:65. [PMID: 32815006 PMCID: PMC7438421 DOI: 10.1186/s40981-020-00371-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/27/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been increasing attention regarding quadratus lumborum block (QLB) and erector spinae plane block (ESPB) as effective truncal blocks. There have been reports of combined QLB and ESPB usage in hip surgery resulting in a symbiotic increase in effectiveness. However, there have been no reports regarding robot-assisted partial nephrectomy (RAPN), which requires multiple port holes ranging from near the xiphoid process to below the umbilicus. We hypothesized that the combined use of QLB and ESPB was an option for anesthesia and analgesia during RAPN. CASE PRESENTATION Anterior QLB and ESPB were applied to two patients undergoing scheduled RAPN. With intravenous patient-controlled analgesia, the post-surgery numerical rating scale scores were < 3/10 at rest and < 5/10 upon movement, throughout the perioperative time. CONCLUSIONS The combination of QLB and ESPB could be an option for the postoperative analgesia in RAPN.
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Affiliation(s)
- Nobuhiro Tanaka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takuzo Kitazawa
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Saki Mitani
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takanori Suzuka
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yuma Kadoya
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Schiavina R, Mari A, Bianchi L, Amparore D, Antonelli A, Artibani W, Brunocilla E, Capitanio U, Fiori C, Di Maida F, Gontero P, Larcher A, Li Marzi V, Longo N, Marra G, Montanari E, Porpiglia F, Roscigno M, Simeone C, Siracusano S, Tellini R, Terrone C, Villari D, Ficarra V, Carini M, Minervini A; Collaborators. Predicting positive surgical margins in partial nephrectomy: A prospective multicentre observational study (the RECORd 2 project). Eur J Surg Oncol 2020; 46:1353-9. [PMID: 32007380 DOI: 10.1016/j.ejso.2020.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/15/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE to evaluate clinical predictors of positive surgical margins (PSMs) in a large multicenter prospective observational study and to develop a clinic nomogram to predict the likelihood of PSMs after partial nephrectomy (PN). MATERIALS AND METHODS We prospectively evaluated 4308 patients who had surgical treatment for renal tumors between January 2013 and December 2016 at 26 urological Italian Centers (RECORd 2 project). Two multivariable logistic models were evaluated to predict the likelihood of PSMs. Center caseload was dichotomized using a visual assessment adjusted for several predictors of PSMs. A nomogram predicting PSMs was developed. RESULTS Overall, 2076 patients treated with PN were evaluated. pT1a, pT1b, pT2 and pT3a were recorded in 68.7%, 22.6%, 2.1% and 6.6% of the patients, respectively. PSMs were recorded in 342 (16.5%) patients. From a null multivariable model against number of PN/year, 60 PN/year were identified as the best cut-off to define a high-volume centre. At multivariable analysis, clinical stage (cT1a vs. cT2 [OR 1.94]; p = 0.03), volume centre (≤60 PN/year) (OR 2.22; p < 0.0001), imperative vs elective indication (OR 2.10; p = 0.04), surgical technique (laparoscopic vs. open [OR 1.62; p = 0.002), lymphovascular invasion (OR 2.27; p = 0.01) and upstaging to pT3a (OR 2.81; p < 0.0001) were independent predictors of PSMs. The final nomogram included age, ASA score, Charlson score, clinical tumor stage, surgical indication, surgical approach, surgical technique, PADUA score, clamp procedure and volume centre. CONCLUSIONS PSMs after PN were significantly more likely in patients with lower clinical stage, higher PADUA score, in individuals referred to laparoscopic PN and in those treated at lower volume centers. We used these data to develop a nomogram to predict such risk.
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Ito T, Sugiyama T, Otsuka A, Miyake H. Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy. BMC Urol 2019; 19:132. [PMID: 31830961 PMCID: PMC6909637 DOI: 10.1186/s12894-019-0567-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/05/2019] [Accepted: 12/02/2019] [Indexed: 01/20/2023] Open
Abstract
Background To assess the impact of volumetry of perinephric fat (PNF) on the perioperative outcomes of robot-assisted partial nephrectomy (RAPN). Methods Between 2016 and 2019, a single surgeon performed RAPN for 128 patients with clinical T1a-b renal tumors at our institution, and the 70 most recent patients were included in this study to minimize the effects of surgical experience. PNF was defined as a fatty area around the kidney within the anatomical structures, including the lateroconal fascia, fusion fascia, psoas muscle, lumbar quadrate muscle and diaphragm, and its volume was calculated based on reconstructed three-dimensional computed tomography images using the SYNAPSE VINCENT system. Results In this series, the trifecta and MIC (margin, ischemia and complications) score system outcomes were achieved in 69 (98.6%) and 64 patients (91.4%), respectively. The median PNF volume in the 70 patients was 166.05 cm3, which was significantly correlated with both the body mass index (BMI) and Mayo adhesive probability (MAP) score (correlation coefficient = 0.68 and 0.74, respectively). There was no significant difference in the R.E.N.A.L. nephrometry score, PNF volume or console time during RAPN among 5 groups consisting of 14 consecutive patients. Of several factors examined, the console time was significantly affected by the sex, MAP score and PNF volume, and only the PNF volume was independently associated with the console time. Conclusion Even if performed by an experienced robotic surgeon beyond the initial learning curve, the PNF volume may influence the console time during RAPN.
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Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
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Zhang Y, Ouyang W, Wu B, Pokhrel G, Ding B, Xu H, Luan Y, Lu Y, Yang J, Wang Z, Yu Y, Li H, Guan W, Wang S, Liu Z. Robot-assisted partial nephrectomy with a standard laparoscopic ultrasound probe in treating endophytic renal tumor. Asian J Surg 2019; 43:423-427. [PMID: 31350090 DOI: 10.1016/j.asjsur.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To report our experience in treating endophytic renal tumor by robot-assisted partial nephrectomy (RPN) with a standard laparoscopic ultrasound probe and our original approach for separating renal mass. METHODS All patients with endophytic renal tumor who underwent RPN in our department from January 2015 to December 2017 were retrospectively analyzed. All surgeries were performed by transperitoneally by a single, experienced surgeon. Baseline characteristics, tumor characteristics, operative profile and follow-up data were collected. RESULTS Among these 29 patients, 23 patients were male. The mean age of patients was 47.42 years old. 69% (20/29) tumors were completely endophytic tumors. The average tumor size was 3.1 cm. The average R.E.N.A.L. score was 9.0. Tumors from 3 patients were pathologically confirmed to be renal angiomyolipomas. And the rest were malignant including 23 clear cell renal cell carcinoma and 3 chromophobe renal cell carcinoma. The mean operative time was 3.0 h. The mean warm ischemia time was 22.3 min. All tumor margins were pathologically confirmed negative. No patient needed blood transfusion. Two patients presented had Grade II complication. Both of them had a fever after surgery with body temperature over 38 °C, leading to a prolonged postoperative hospitalization time. The mean postoperative hospitalization time was 6.8 days. During mean 21.3-month follow-up, no patient was confirmed to relapse by CT scan. CONCLUSION RPN with a standard laparoscopic ultrasound probe is safe, effective and feasible in treating endophytic renal tumor. Our original approach for separating renal mass can avoid some problems caused by the standard laparoscopic ultrasound probe.
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Affiliation(s)
- Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China; Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Bolin Wu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Beichen Ding
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Hao Xu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Yang Luan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Jun Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Yang Yu
- Department of Ultrasonography, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Heng Li
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Wei Guan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China.
| | - Zheng Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou, Wuhan, Hubei, 430030, China.
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Buffi NM, Saita A, Lughezzani G, Porter J, Dell'Oglio P, Amparore D, Fiori C, Denaeyer G, Porpiglia F, Mottrie A. Robot-assisted Partial Nephrectomy for Complex (PADUA Score ≥10) Tumors: Techniques and Results from a Multicenter Experience at Four High-volume Centers. Eur Urol 2019; 77:95-100. [PMID: 30898407 DOI: 10.1016/j.eururo.2019.03.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Robot-assisted partial nephrectomy (RAPN) represents a widely accepted minimally invasive alternative to open and laparoscopic surgery for the treatment of clinically localized renal tumors. OBJECTIVE To assess the feasibility of RAPN in a contemporary series of patients with highly complex tumors (PADUA score ≥10) treated at four high-volume robotic surgery institutions. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively maintained multi-institutional database on patients subjected to RAPN between 2010 and 2017 were reviewed. For the scope of this analysis, only patients with highly complex renal tumors, defined as a PADUA score between 10 and 14, were included. SURGICAL PROCEDURE RAPN was performed with the da Vinci Si or Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) using novel technologies such as TilePro and near-infrared fluorescence imaging. MEASUREMENTS Intraoperative, postoperative, surgical, and oncological outcomes were collected. Predictors of optimal surgical outcomes defined according to the Margin Ischemia and Complications binary system (absence of Clavien-Dindo >2 complications, warm ischemia time [WIT] <20min, and absence of positive surgical margins) were determined using logistic regression models (LRMs). RESULTS AND LIMITATIONS Overall, 255 patients with complex renal tumors were included. The mean operative time was 165min and mean WIT was 18.6min. Overall, WIT was longer than 20min in 86 (33.7%) individuals, while a Clavien-Dindo >2 complication and positive surgical margins were observed in 13 (5.1%) and four (out of 211 patients with malignant histotypes; 1.9%) individuals, respectively. Optimal surgical outcomes were achieved in 158 (62.0%) patients. At a median follow-up of 28mo, one (0.4%) local and two (0.8%) distant recurrences of the disease were observed. In multivariable LRMs, extremely complex tumors (PADUA score 12-13) were associated with an increased likelihood of not achieving optimal outcomes (odds ratio: 2.31; p=0.024). Besides tumor complexity, male gender was also associated with a two-fold higher risk of not achieving optimal surgical outcomes (p=0.029). CONCLUSIONS In experienced hands, RAPN can be considered as an effective treatment option even in cases of complex renal lesions. However, increasing tumor complexity may affect the surgical outcomes in this highly selected patient population. PATIENT SUMMARY We reported our multicentric experience with robot-assisted partial nephrectomy (RAPN) in patients with complex renal tumors. We demonstrated that, in experienced hands, RAPN is a feasible and safe treatment option even in such patients. Novel technologies applied to RAPN may further extend the indications without compromising the outcomes.
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Affiliation(s)
- Nicolò Maria Buffi
- Humanitas Clinical and Research Center, Milan, Italy; Humanitas University, Milan, Italy
| | - Alberto Saita
- Humanitas Clinical and Research Center, Milan, Italy
| | | | | | - Paolo Dell'Oglio
- Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Robotic Surgery Institute Academy, Melle, Belgium
| | | | - Cristian Fiori
- School of Medicine, San Luigi Gonzaga Hospital, Turin, Italy
| | - Geert Denaeyer
- Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Robotic Surgery Institute Academy, Melle, Belgium
| | | | - Alex Mottrie
- Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Robotic Surgery Institute Academy, Melle, Belgium
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Ito T, Sugiyama T, Otsuka A, Miyake H. Improved perioperative outcomes by early unclamping prior to renorrhaphy compared with conventional clamping during robot-assisted partial nephrectomy: a propensity score matching analysis. J Robot Surg 2020; 14:47-53. [PMID: 30712250 DOI: 10.1007/s11701-019-00924-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/18/2019] [Indexed: 01/20/2023]
Abstract
The objective of this study was to evaluate the impact of the early unclamping (EU) technique on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy (RAPN). This study included 96 patients with small renal masses who underwent RAPN performed by a single surgeon using the da Vinci Xi between April 2016 and September 2018. EU and conventional clamping (CC) procedures were defined as those removing the renal artery clamp before and after renorrhaphy, respectively. In this series, contrast-enhanced computed tomography was performed 3-5 days after RAPN to examine the incidence of renal artery pseudoaneurysm (RAP). After adjusting patient variables by 1:1 propensity score matching, 45 patients were included in both the EU and CC groups, and no significant differences in major clinical characteristics were noted between these two groups. Although there was no significant difference in the proportion of patients achieving trifecta or the margin, ischemia and complications score between the two groups, the EU group was significantly superior to the CC group regarding the operative time, console time, warm ischemia time, impairment of renal function 1 day after RAPN, incidence of RAP and postoperative length of hospital stay. Furthermore, RAP occurred in seven patients in the entire cohort (13.3%) receiving CC, including two who required trans-arterial embolization due to severe macrohematuria, whereas RAP was completely prevented by the use of EU. The introduction of the EU technique to RAPN may improve perioperative outcomes, particularly by markedly reducing the risk of RAP even with renorrhaphy.
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Dell'Oglio P, De Naeyer G, Xiangjun L, Hamilton Z, Capitanio U, Ripa F, Cianflone F, Muttin F, Schatteman P, D'Hondt F, Ma X, Bindayi A, Zhang X, Derweesh I, Mottrie A, Montorsi F, Larcher A; ERUS Educational Working Group and the YAU working group on robot-assisted surgery. The Impact of Surgical Strategy in Robot-assisted Partial Nephrectomy: Is It Beneficial to Treat Anterior Tumours with Transperitoneal Access and Posterior Tumours with Retroperitoneal Access? Eur Urol Oncol 2021; 4:112-6. [PMID: 31411997 DOI: 10.1016/j.euo.2018.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
Available comparison of transperitoneal robot-assisted partial nephrectomy (tRAPN) and retroperitoneal robot-assisted partial nephrectomy (rRAPN) does not consider tumour's location. The aim of this study was to compare perioperative morbidity, and functional and pathological outcomes after tRAPN and rRAPN, with the specific hypothesis that tRAPN for anterior tumours and rRAPN for posterior tumours might be a beneficial strategy. A large global collaborative dataset of 1169 cT1-2N0M0 patients was used. Propensity score matching, and logistic and linear regression analyses tested the effect of tRAPN versus rRAPN on perioperative outcomes. No differences were observed between rRAPN and tRAPN with respect to complications, operative time, length of stay, ischaemia time, median 1-yr estimated glomerular filtration rate (eGFR), and positive surgical margins (all p>0.05). Median estimated blood loss and postoperative eGFR were 50 versus100ml (p<0.0001) and 82 versus 78ml/min/1.73 m2 (p=0.04) after rRAPN and tRAPN, respectively. At interaction tests, no advantage was observed after tRAPN for anterior tumours and rRAPN for posterior tumours with respect to complications, warm ischaemia time, postoperative eGFR, and positive surgical margins (all p>0.05). The techniques of rRAPN and tRAPN offer equivalent perioperative morbidity, and functional and pathological outcomes, regardless of tumour's location. PATIENT SUMMARY: Robot-assisted partial nephrectomy can be performed with a transperitoneal or a retroperitoneal approach regardless of the specific position of the tumour, with equivalent outcomes for the patient.
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Teishima J, Takayama Y, Iwaguro S, Hayashi T, Inoue S, Hieda K, Shinmei S, Kato R, Mita K, Matsubara A. Usefulness of personalized three-dimensional printed model on the satisfaction of preoperative education for patients undergoing robot-assisted partial nephrectomy and their families. Int Urol Nephrol 2018; 50:1061-1066. [PMID: 29744824 DOI: 10.1007/s11255-018-1881-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/23/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To clarify the usefulness of a personalized three-dimensional (3D) printed model of the kidney for preoperative education among patients who underwent robot-assisted partial nephrectomy (RAPN). METHODS Twenty-nine cases of patients who planned to undergo RAPN and 19 of their families participated in this study. A three-dimensional model consisting of the kidney, tumors, ureter, inferior vena cava, and abdominal aorta in each case was generated using a Z Printer 450 based on the findings of preoperative enhanced CT. After preoperative education using enhanced CT and a 3D-printed model, two anatomy-related issues, three tumor-related issues, and two surgical procedure-related issues were evaluated using a visual analogue scale. RESULTS The median age of all participants was 64 years old. The rate in male patients was significantly higher than that in families. In all three issues in patients and in two of three issues in families, scores in the 3D model were significantly higher than those in CT. In all issues in CT, scores of patients 64 years old or younger were higher than those of patients 65 years old or higher. On the other hand, no significant difference was found in the 3D model for scores on two of three issues regardless of the age of participants. CONCLUSION Our data indicate that the personalized 3D printed model of the kidney is useful for preoperative education among patients and their families who underwent RAPN, especially in elderly people.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yukihiro Takayama
- Department of Clinical Practice and Support, Division of Dental Technician, Hiroshima University Hospital, Hiroshima, Japan
| | - Shogo Iwaguro
- Department of Clinical Practice and Support, Division of Dental Technician, Hiroshima University Hospital, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Keisuke Hieda
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shunsuke Shinmei
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Ryoji Kato
- Department of Clinical Practice and Support, Division of Dental Technician, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Mita
- Department of Urology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Tufek I, Mourmouris P, Doganca T, Obek C, Argun OB, Tuna MB, Keskin MS, Kural AR. Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes. JSLS 2017; 21:JSLS.2016.00113. [PMID: 28352149 PMCID: PMC5357684 DOI: 10.4293/jsls.2016.00113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: “Trifecta” in partial nephrectomy consists of negative surgical margins, minimal renal function decrease and absence of complications. In the present article, our single-center robot-assisted partial nephrectomy (RAPN) experience in T1b renal masses is reported in terms of strict Trifecta outcomes. Methods: This is a retrospective analysis of patients with a tumor diameter between 4 and 7 cm (stage T1b), who underwent RAPN by a single surgeon. Preoperative, intraoperative, and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Patients with absence of grade ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤25 minutes, ≤15% postoperative estimated glomerular filtration rate (eGFR) decrease and negative surgical margins were reported to achieve strict Trifecta outcomes. P < .05 was indicated statistically significant. Results: A total of 150 patients underwent RAPN, and 50 patients were identified with tumor size between 4 and 7 cm. Mean WIT was 20.8 ± 6.2 minutes and mean estimated blood loss (EBL) was 269 ± 191 mL. Surgical margins were negative in all patients. Eleven patients (22%) had a >15% eGFR decrease after surgery. Nine patients (18%) had WIT longer than 25 minutes. Four patients (8%) had grade ≥2 Clavien-Dindo complications. Twenty-nine (58%) patients had strict Trifecta outcomes. Mean follow-up was 44.2 ± 27.2 months. Tumor recurrence was not observed in any patient. Conclusions: Robot-assisted laparoscopic partial nephrectomy for T1b renal masses can be safely performed in experienced hands. Optimal strict Trifecta outcomes and recurrence rates can be achieved.
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Affiliation(s)
- Ilter Tufek
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Panagiotis Mourmouris
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Tunkut Doganca
- Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey
| | - Can Obek
- Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey
| | - Omer Burak Argun
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | | | - Mehmet Selcuk Keskin
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Ali Rıza Kural
- Department of Urology, Acıbadem Maslak Hospital, Istanbul, Turkey
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Shen Z, Xie L, Xie W, Hu H, Chen T, Xing C, Liu X, Xu H, Zhang Y, Wu Z, Tian D, Wu C. The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis. World J Surg Oncol 2016; 14:220. [PMID: 27549155 PMCID: PMC4994255 DOI: 10.1186/s12957-016-0971-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 12/16/2015] [Accepted: 08/03/2016] [Indexed: 12/27/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has been widely used worldwide, to determine whether RAPN is a safe and effective alternative to open partial nephrectomy (OPN) via the comparison of RANP and OPN. Methods A comprehensive literature search was performed within the databases including PubMed, Cochrane Library, and Embase updated on 30 September 2015. Summary data with their corresponding 95 % confidence intervals (CIs) were calculated using a random effects or fixed effects model. Heterogeneity and publication bias were also evaluated. Results A total of 16 comparative studies including 3024 cases were used for this meta-analysis. There are no significant differences in the demographic characteristic between the two groups, but the age was lower and the tumor size was smaller for the RAPN group. RAPN had a longer operative time and warm ischemia time but which showed less estimated blood loss, hospital stay, and perioperative complications. No differences existed in the margin status, the change of glomerular filtration rate, transfusion rate, and conversion rate between the two groups. There was no significant publication bias. Conclusions RAPN offered a lower rate of perioperative complications, less estimated blood loss, and shorter length of hospital stay than OPN, suggesting that RAPN can be an effective alternative to OPN. Well-designed prospective randomized controlled trials will be helpful in validating our findings.
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Affiliation(s)
- Zhonghua Shen
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Linguo Xie
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wanqin Xie
- Key Laboratory of Genetics and Birth Health of Hunan Province, The Family Planning Research Institute of Hunan Province, Changsha, Hunan, 410126, China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tao Chen
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Chen Xing
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Xiaoteng Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China
| | - Hao Xu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yu Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Zhouliang Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Dawei Tian
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China. .,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Changli Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China. .,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Castillo O, Rodríguez-Carlin A, Borgna V. Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up. Actas Urol Esp 2016; 40:217-23. [PMID: 26811020 DOI: 10.1016/j.acuro.2015.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). MATERIALS AND METHOD Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n=43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. RESULTS The patients' mean age was 53.1±13.5 years. The mean preoperative tumour size was 3.7±2.3cm. The mean surgical time was 102.2±37.1min. The mean ischemia time was 21.27±7.74minutes, with a median intraoperative bleeding volume of 150mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien≥III). There was no mortality. The average Fürhman grade was 2.5±0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38±8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04±28.17mL/min/1.73m(2), and the postoperative rate was 89.9±27.69mL/min/1.73m(2), with a nonsignificant reduction (P=.74). CONCLUSIONS The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term.
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Cornejo-Dávila V, Nazmy M, Kella N, Palmeros-Rodríguez MA, Morales-Montor JG, Pacheco-Gahbler C. Use of near infrared fluorescence during robot-assisted laparoscopic partial nephrectomy. Actas Urol Esp 2016; 40:190-4. [PMID: 26598421 DOI: 10.1016/j.acuro.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Partial nephrectomy is the treatment of choice for T1a tumours. The open approach is still the standard method. Robot-assisted laparoscopic surgery offers advantages that are applicable to partial nephrectomy, such as the use of the Firefly® system with near-infrared fluorescence. OBJECTIVE To demonstrate the implementation of fluorescence in nephron-sparing surgery. CASE REPORT This case concerned a 37-year-old female smoker, with obesity. The patient had a right kidney tumour measuring 31 mm, which was found using tomography. She therefore underwent robot-assisted laparoscopic partial nephrectomy, with a warm ischaemia time of 22 minutes and the use of fluorescence with the Firefly® system to guide the resection. There were no complications. The tumour was a pT1aN0M0 renal cell carcinoma, with negative margins. Robot-assisted renal laparoscopic surgery is employed for nephron-sparing surgery, with good oncological and functional results. The combination of the Firefly® technology and intraoperative ultrasound can more accurately delimit the extent of the lesion, increase the negative margins and decrease the ischaemia time. CONCLUSION Near-infrared fluorescence in robot-assisted partial nephrectomy is useful for guiding the tumour resection and can potentially improve the oncological and functional results.
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Affiliation(s)
- V Cornejo-Dávila
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México.
| | - M Nazmy
- The Urology and Prostate Institute, San Antonio, Texas, Estados Unidos de, América
| | - N Kella
- The Urology Place , San Antonio, Texas, Estados Unidos de, América
| | - M A Palmeros-Rodríguez
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
| | - J G Morales-Montor
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
| | - C Pacheco-Gahbler
- División de Urología, Hospital General «Dr. Manuel Gea González», S.S.A., México, D.F., México
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Camara M, Mayer E, Darzi A, Pratt P. Soft tissue deformation for surgical simulation: a position-based dynamics approach. Int J Comput Assist Radiol Surg 2016; 11:919-28. [PMID: 26995599 PMCID: PMC4893362 DOI: 10.1007/s11548-016-1373-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 01/28/2016] [Accepted: 02/26/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE To assist the rehearsal and planning of robot-assisted partial nephrectomy, a real-time simulation platform is presented that allows surgeons to visualise and interact with rapidly constructed patient-specific biomechanical models of the anatomical regions of interest. Coupled to a framework for volumetric deformation, the platform furthermore simulates intracorporeal 2D ultrasound image acquisition, using preoperative imaging as the data source. This not only facilitates the planning of optimal transducer trajectories and viewpoints, but can also act as a validation context for manually operated freehand 3D acquisitions and reconstructions. METHODS The simulation platform was implemented within the GPU-accelerated NVIDIA FleX position-based dynamics framework. In order to validate the model and determine material properties and other simulation parameter values, a porcine kidney with embedded fiducial beads was CT-scanned and segmented. Acquisitions for the rest position and three different levels of probe-induced deformation were collected. Optimal values of the cluster stiffness coefficients were determined for a range of different particle radii, where the objective function comprised the mean distance error between real and simulated fiducial positions over the sequence of deformations. RESULTS The mean fiducial error at each deformation stage was found to be compatible with the level of ultrasound probe calibration error typically observed in clinical practice. Furthermore, the simulation exhibited unconditional stability on account of its use of clustered shape-matching constraints. CONCLUSIONS A novel position-based dynamics implementation of soft tissue deformation has been shown to facilitate several desirable simulation characteristics: real-time performance, unconditional stability, rapid model construction enabling patient-specific behaviour and accuracy with respect to reference CT images.
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Affiliation(s)
- Mafalda Camara
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Erik Mayer
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Philip Pratt
- Department of Surgery and Cancer, Imperial College London, London, UK
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Abstract
Robotic surgery was initially developed to overcome problems faced during conventional laparoscopic surgeries and to perform telesurgery at distant locations. It has now established itself as the epitome of minimally invasive surgery (MIS). It is one of the most significant advances in MIS in recent years and is considered by many as a revolutionary technology, capable of influencing the future of surgery. After its introduction to urology, robotic surgery has redefined the management of urological malignancies. It promises to make difficult urological surgeries easier, safer and more acceptable to both the surgeon and the patient. Robotic surgery is slowly, but surely establishing itself in India. In this article, we provide an overview of the advantages, disadvantages, current status, and future applications of robotic surgery for urologic cancers in the context of the Indian scenario.
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Affiliation(s)
- Saurabh Jain
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Gagan Gautam
- Department of Urology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, Haryana, India
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Patel TH, Babbar P, Hemal AK. The emergence of surgeon-controlled robotic surgery in urologic oncology. Indian J Surg Oncol 2012; 3:77-84. [PMID: 23730094 DOI: 10.1007/s13193-011-0105-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022] Open
Abstract
The rise of robotic surgery is transforming medicine. In many ways, urology has taken charge in pioneering a new era of minimally invasive surgery with the emergence of the robot. The unprecedented dissecting precision and the dynamic three-dimensional, high definition view of the surgical field are undoubtedly revolutionizing the field of urology. These unique attributes of robotic surgery confer enormous advantages in dealing with uro-oncological surgery. The robotic revolution began nearly a decade ago with surgeon-controlled robotic radical prostatectomy and has since expanded to include radical cystectomies and partial nephrectomies. There have been numerous landmark studies published showing that robotic surgery provides comparable oncological and functional outcomes against traditional open or laparoscopic surgery. As a result, it becomes exceedingly imperative that urologists and the oncological community remain up-to-date regarding these developments and appreciate the oncological outcomes of surgeon-controlled robotic surgery. This review will assess the impact surgeon-controlled robotic surgery has had in the field of urologic oncology.
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