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Hu Y, Huang S, Guo C, Hong G, Wu Y, Xu S. Performance Prediction for Surgical Outcomes in Laparoscopic Partial Nephrectomy Using Nephrometry Scores: A Comparison of Zhongshan and Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location Systems. J Laparoendosc Adv Surg Tech A 2024; 34:323-328. [PMID: 38330407 DOI: 10.1089/lap.2023.0502] [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] [Indexed: 02/10/2024] Open
Abstract
Objective: The aim of this study is to compare the precision and applicability of the Zhongshan (ZS) score against the radius, exophytic/endophytic, nearness, anterior/posterior, and location (RENAL) score in forecasting perioperative outcomes during laparoscopic partial nephrectomy (LPN). Materials and Methods: We retrospectively analyzed data from 99 renal cancer patients who underwent LPN between January 2017 and August 2023. Patients were scored and categorized based on both the ZS and RENAL scores. The study then compared perioperative outcomes across these groups and further investigated the correlation between ZS and RENAL scores and overall complication rates. Results: LPN was successfully accomplished in 94 patients, whereas 5 patients necessitated conversion to open or radical surgery. The high-risk group, according to the ZS score, manifested more warm ischemic time (WIT) than the low-risk group (P = .007). Furthermore, the incidence of overall complications escalated with increase in the ZS score grade (P = .045). A higher RENAL score corresponded to a greater risk of conversion to open or radical treatment (P = .012). Correlation analyses revealed associations between both ZS and RENAL scores and overall complications. The RENAL score also correlated with changes in blood creatinine values, while the ZS score was associated with WIT (all P < .05). In the univariate analysis, both ZS and RENAL scores were substantial factors for the occurrence of total complications (P = .029 and P = .027, respectively), but they were not statistically significant in the multivariate analysis. The receiver operating characteristic curves suggested that both individual and combined ZS and RENAL scores held predictive potential for the onset of overall complications (area under the curve = 0.652, 0.660, and 0.676, respectively). Conclusions: Compared with the RENAL score, the ZS score provides a more comprehensive assessment of tumor complexity in patients undergoing LPN. Integrating these two scores could potentially improve the accuracy of predicting surgical risks.
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Affiliation(s)
- Yang Hu
- Graduate School of Medicine, Zunyi Medical University, Zunyi, China
| | - Shiyu Huang
- Graduate School of Medicine, Zunyi Medical University, Zunyi, China
| | - Cici Guo
- Graduate School of Medicine, Guizhou Medical University, Guiyang, China
| | - Guangyi Hong
- School of Medicine, Guizhou University, Guiyang, China
| | - Yikun Wu
- School of Medicine, Guizhou University, Guiyang, China
| | - Shuxiong Xu
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China
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Mendes G, Madanelo M, Vila F, Versos R, Teixeira BL, Rocha MA, Mesquita S, Marques-Monteiro M, Príncipe P, Ramires R, Lindoro J, Fraga A, Silva-Ramos M. Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A Retrospective, Multi-Center, Comparative Study. J Clin Med 2024; 13:701. [PMID: 38337397 PMCID: PMC10856370 DOI: 10.3390/jcm13030701] [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: 01/10/2024] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients' data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.
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Affiliation(s)
- Gonçalo Mendes
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Fernando Vila
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Rui Versos
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Maria Alexandra Rocha
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Ricardo Ramires
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Joaquim Lindoro
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Avelino Fraga
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
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Tian YQ, Ren X, Yin YS, Wang J, Li X, Guo ZH, Zeng XY. Analysis of risk factors affecting the postoperative drainage after a laparoscopic partial nephrectomy: a retrospective study. Front Med (Lausanne) 2024; 11:1327882. [PMID: 38327705 PMCID: PMC10847592 DOI: 10.3389/fmed.2024.1327882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose Laparoscopic partial nephrectomy (LPN) remains the most commonly used measure for treating localized renal cell cancer (RCC) with an increasing incidence of RCC ever since the 1990s. This study aimed to identify risk factors that affect the postoperative time of drainage and total drainage volume after LPN. Method The clinical data of 612 RCC patients who received LPN from January 2012 to December 2022 in our hospital, including the postoperative drainage time and total drainage volume, were retrospectively analyzed. Univariable and multivariable linear regression and correlation analyses were used to identify the correlations between 21 factors, which include gender, age, history of alcohol consumption, family history of RCC, body weight, body mass index (BMI), and operation time, postoperative drainage time, and total drainage volume. Results The mean time of drainage was 3.52 ± 0.71 days (range: 2 to 8 days), with an average total drainage volume of 259.83 ± 72.64 mL (range: 50 to 620 mL). Both univariable and multivariable linear regression analyses revealed several statistically significant associations. Gender (p = 0.04), age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.032), operation time (p = 0.014), and BMI (p = 0.023) were identified as significant factors associated with the time of drainage. On the other hand, age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.006), and BMI (p = 0.016) emerged as independent risk factors influencing the total drainage volume. Conclusion The duration of postoperative drainage was found to be associated with gender, age, smoking history, diabetes, operation time, and BMI. In contrast, the total drainage volume was primarily influenced by age, smoking history, diabetes, and high BMI following LPN. For patients with these conditions, meticulous attention to hemostasis and bleeding control is crucial during the perioperative period.
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Affiliation(s)
- Yi-Qun Tian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xiang Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Yi-Sheng Yin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Jing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xing Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Zi-Hao Guo
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
| | - Xiao-Yong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- China Institute of Urology of Hubei Province, Wuhan, Hubei, China
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Zhang F, Hu JS, Zhang KY, Liu XH. Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis. Front Oncol 2024; 13:1283935. [PMID: 38273858 PMCID: PMC10809712 DOI: 10.3389/fonc.2023.1283935] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background The primary aim of this present study is to undertake a comprehensive comparative analysis of the perioperative, functional, and oncologic outcomes associated with laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) as interventions for the treatment of complex renal tumors, defined as PADUA or RENAL score ≥ 7. Methods We systematically carried out an extensive search across four electronic databases, namely PubMed, the Cochrane Library, Embase, and Web of Science. Our objective was to identify pertinent studies published in the English language up to December 2023, and encompassed controlled trials comparing LPN and OPN as interventions for complex renal tumors. Results This study encompassed a total of seven comparative trials, involving 934 patients. LPN exhibited a noteworthy reduction in the length of hospital stay (weighted mean difference [WMD] -2.06 days, 95% confidence interval [CI] -2.62, -1.50; p < 0.00001), blood loss (WMD -34.05mL, 95% CI -55.61, -12.48; p = 0.002), and overall complications (OR 0.38, 95% CI 0.19, 0.79; p = 0.009). However, noteworthy distinctions did not arise between LPN and OPN concerning parameters such as warm ischemia time, renal function, and oncological outcomes. Conclusions This study reveals that LPN presents several advantages over OPN. These benefits encompass a shortened hospital stay, diminished blood loss, and a reduced incidence of complications. Importantly, LPN achieves these benefits while concurrently upholding comparable renal function and oncological outcomes. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=457716, identifier CRD42023453816.
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Affiliation(s)
| | | | | | - Xiao-hua Liu
- Department of Urology, Minda Hospital of Hubei Minzu University, En Shi, China
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Tsakiris S, Zerva M, Paparidis S, Gasparos F, Tzoras A, Samis A, Bouropoulos C, Ferakis N. Three Dimensional (3D) Laparoscopic Nephron-sparing Treatment of a Huge Cystic Nephroma: A Case Report and Literature Review. Cancer Diagn Progn 2024; 4:81-84. [PMID: 38173662 PMCID: PMC10758847 DOI: 10.21873/cdp.10290] [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] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
Background/Aim Cystic nephroma (CN) is a very rare, benign, renal cystic lesion, which is characterized by a usually unilateral, multicystic kidney mass. In adults it is seen more frequently in females (1:8 male-to-female ratio). The peak incidence of CN is between 50 and 60 years of age. Median age at diagnosis is 55 years for females and 44 years for men and it is a rare entity in adults under 30 years of age. Case Report We report the case of a 52-year-old female patient with chronic right-flank pain, who was treated at our hospital. A multiloculated 10×8.6 cm Bosniak IV renal cyst tumor was depicted on retroperitoneal computed tomography. After a three-dimensional laparoscopic partial nephrectomy, the histopathological specimen examination revealed: a multilocular cystic nephroma. Conclusion CNs are rare benign tumors that should be included in the differential diagnosis when treating large multiloculated complex renal cysts.
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Affiliation(s)
- Savvas Tsakiris
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Maria Zerva
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Spyridon Paparidis
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Fotis Gasparos
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Aggelos Tzoras
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | - Alexandros Samis
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
| | | | - Nikolaos Ferakis
- Urology Department, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, Greece
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Zhang H, Wang J, Liu C, Du B, Xiao J, Qian L, Zhang Q, Li J. Development of a continuously perfused ex vivo kidney training model for laparoscopic partial nephrectomy: validity and efficiency. Int J Surg 2023; 109:3919-3928. [PMID: 37737884 PMCID: PMC10720863 DOI: 10.1097/js9.0000000000000753] [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: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Suture hemostasis is essential for laparoscopic partial nephrectomy (LPN). This study aimed to develop, validate, and test the efficacy of a continuously perfused training model (CPTM) in LPN with high-level simulated bleeding. MATERIALS AND METHODS The CPTM was constructed using fresh porcine kidneys with renal arteries continuously perfused with red-dyed liquid gelatin. Twenty-nine participants with expert, intermediate, or novice laparoscopic experience levels were recruited. The expert and intermediate participants evaluated the CPTM, and the novice participants were randomly assigned to one of two groups to complete training on a CPTM or dry box training model (DBTM). Messick's framework criteria were utilized to assess the validity and training efficacy of the model. The data were analyzed using the Mann-Whitney U , Kruskal-Wallis, and Friedman tests. A value of P< 0.05 was considered statistically significant. RESULTS Positive comments were provided by all experts and intermediates for the Content . The Relationships with other variables demonstrated significant differences among novices, intermediates, and experts in all metrics ( P< 0.05). The Consequences showed that the CPTM helped novices acquire LPN skills. The training efficacy was significantly better than that of the DBTM ( P< 0.05). There were no significant differences between the final performances of the novices and the initial performances of the experts ( P >0.05). Synthesizing all metrics, the LPN skills learned using CPTMs were significantly improved in the 12th round of training. CONCLUSION The CPTM offered a high-level simulation of bleeding with realistic tissue texture for acquiring LPN skills. Training of no fewer than 12 rounds is recommended for a novice's LPN training on the CPTM.
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Affiliation(s)
| | - Jun Wang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
| | - Chundong Liu
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou
| | - Bingran Du
- Department of Stomatology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan
| | - Jujiao Xiao
- Center of Clinical Skills, Affiliated Jining First People's Hospital, Shandong First Medical University, Jining
| | - Lei Qian
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
| | - Qun Zhang
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences
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Kurbanov A A, Chernov Ya N, Chinenov D V, Tsukkiev Z K, Votyakov A Y, Lerner Yu V, Sutugin K E, Shpot E V. [Minimizing the number of trocars during laparoscopic partial nephrectomy. Surgical technique]. Urologiia 2023:102-107. [PMID: 38156691] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION During last 20 years in urology there has been a number of significant advancements, which were due to the introduction into practice and improvement of minimally invasive techniques. Development of laparoscopic surgery allowed to actively introduce these procedures in various kidney disorders, including renal tumors. Laparoscopic partial nephrectomy is also undergoing changes in order to improve the technique. Standard technique requires four or more trocars, where fourth (additional) trocar is put for the assistant. However, there is an opinion that in most cases it is possible to perform partial nephrectomy without an assistant trocar, while maintaining the safety and efficiency of the procedure and improving some perioperative outcomes. The aim of our study was to compare the safety and efficiency of the three-trocar and four-trocar techniques during transperitoneal partial nephrectomy. This article also presents the technical features of laparoscopic partial nephrectomy. MATERIALS AND METHODS Between 2021 and 2023, a total of 200 patients were included in the study comparing three- and four-trocar partial nephrectomy. RESULTS There was no difference in the rate of achieving renal trifecta between the two groups. In the three-trocar group, 94 cases of renal trifecta were found, while in the four-trocar group, there were 95 patients with renal trifecta. CONCLUSIONS The three-trocar technique is not inferior in safety and efficiency to the standard four-trocar technique. The main advantages of the three-trocar technique are less pain, cost and post-operative scarring.
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Affiliation(s)
- A Kurbanov A
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - N Chernov Ya
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - V Chinenov D
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - K Tsukkiev Z
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - Yu Votyakov A
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - V Lerner Yu
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - E Sutugin K
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
| | - V Shpot E
- Institute for Urology and Human Reproductive Health of FGAOU I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, Obninsk, Russia
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Biktimirov TR, Martov AG, Biktimirov RG, Baranov AV, Kaputovskiy AA, Khitrikh AM, Amosov NA, Tokareva ES. [Laparoscopic right-side partial nephrectomy with fluorescence imaging in the near infrared spectrum using indocyanine green]. Urologiia 2023:121-124. [PMID: 37855239] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
A clinical case of the use of fluorescence imaging in the near infrared spectrum with indocyanine green during laparoscopic right-side partial nephrectomy is presented in the article.
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Affiliation(s)
- T R Biktimirov
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A G Martov
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - R G Biktimirov
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A V Baranov
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A A Kaputovskiy
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A M Khitrikh
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - N A Amosov
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E S Tokareva
- Federal Clinical Center for HMT, Moscow region, Khimki, md. Novogorsk, Russia
- Department of Urology and Andrology of Federal Medical and Biological Center named after A.I. Burnazyan FMBA RF, Moscow, Russia
- O.K. Skobelkin State Scientific Center of Laser Medicine, Moscow, Russia
- GBUZ Moscow district Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D'Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "Could Patient Age and Gender, along with Mass Size, Be Predictive Factors for Benign Kidney Tumors?": A Retrospective Analysis of 307 Consecutive Single Renal Masses Treated with Partial or Radical Nephrectomy. Bioengineering (Basel) 2023; 10:794. [PMID: 37508821 PMCID: PMC10376757 DOI: 10.3390/bioengineering10070794] [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: 03/24/2023] [Revised: 05/29/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Due to the increased use of common and non-invasive abdominal imaging techniques over the last few decades, the diagnosis of about 60% of renal tumors is incidental. Contrast-enhancing renal nodules on computed tomography are diagnosed as malignant tumors, which are often removed surgically without first performing a biopsy. Most kidney nodules are renal cell carcinoma (RCC) after surgical treatment, but a non-negligible rate of these nodules may be benign on final pathology; as a result, patients undergo unnecessary surgery with an associated significant morbidity. Our study aimed to identify a subgroup of patients with higher odds of harboring benign tumors, who would hence benefit from further diagnostic examinations (such as renal biopsy) or active surveillance. We performed a retrospective review of the medical data, including pathology results, of patients undergoing surgery for solid renal masses that were suspected to be RCCs (for a total sample of 307 patients). Owing to the widespread use of common and non-invasive imaging techniques, the incidental diagnosis of kidney tumors has become increasingly common. Considering that a non-negligible rate of these tumors is found to be benign after surgery at pathological examination, it is crucial to identify features that can correctly diagnose a mass as benign or not. According to our study results, female sex and tumor size ≤ 3 cm were independent predictors of benign disease. Contrary to that demonstrated by other authors, increasing patient age was also positively linked to a greater risk of malign pathology.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D'Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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10
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Tanaka T, Yoshida T, Maegawa Y, Nakagawa M, Kishikawa H. Fat Necrosis Mimicking Local Recurrence With Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) Positivity After Partial Nephrectomy for Renal Cell Carcinoma. Cureus 2023; 15:e40327. [PMID: 37448417 PMCID: PMC10338067 DOI: 10.7759/cureus.40327] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
We report a case of fat necrosis with positive results on fluorodeoxyglucose positron emission tomography (FDG-PET)-CT imaging after partial nephrectomy. A 77-year-old man underwent a partial nephrectomy for a right renal mass. The histopathological results showed clear cell renal cell carcinoma, G1>G2, pT1a. Four and a half years after surgery, a nodule appeared in the retroperitoneal space on CT. FDG-PET CT showed increased uptake in the nodule, indicating local recurrence of carcinoma. A right nephrectomy was performed. The histopathological diagnosis was fat necrosis.
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Affiliation(s)
| | - Takahiro Yoshida
- Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, JPN
| | - Yoko Maegawa
- Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, JPN
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11
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Nguyen HN, Yamada A, Naka S, Mukaisho KI, Tani T. Feasibility of Microwave Scissors-Based Off-Clamp Laparoscopic Partial Nephrectomy in a Porcine Model. Surg Innov 2023:15533506231165830. [PMID: 36961743 DOI: 10.1177/15533506231165830] [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] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To assess the feasibility of off-clamp laparoscopic partial nephrectomy using microwave scissors. METHODS We performed transperitoneal laparoscopic partial nephrectomy, without hilar clamping or renorrhaphy, using only microwave scissors for renal resection in a porcine model. For each kidney, 2 types of procedures were performed: a middle pole resection excising an area of 2-cm diameter and approximately 1-cm depth and a lower pole resection at the level of the lower polar line. The renal calyces exposed during renal resection were sealed and transected using microwave scissors. After 3 days of follow-up, the pigs were reoperated to inspect for postoperative complications. Euthanasia was performed to collect the remaining kidneys for histopathological examination. RESULTS Ten procedures were successfully performed, without hilar clamping or suturing of the renal calyces and parenchyma, in 5 kidneys from 3 pigs. The median resecting time, blood loss, and lateral thermal injury were 23.2 min, 47.1 mL, and 6.8 mm in the middle pole resection, and were 15.1 min, 26.5 mL, and 6.9 mm in the lower pole resection, respectively. No complications were noted during reoperation, such as postoperative hemorrhage and major urine leakage. Extravasation occurred in 2 middle pole resections and 3 lower pole resections during retrograde pyelogram. Hematoxylin and eosin staining revealed thermal injury characterized by tissue microwave fixation in the near zone and acute coagulative necrosis in the intermediate zone. CONCLUSIONS Microwave scissors-based off-clamp laparoscopic partial nephrectomy is feasible in pigs and can be used for clinical applications.
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Affiliation(s)
- Ha Ngoc Nguyen
- Department of Research and Development for Innovative Medical Devices and Systems, 13051Shiga University of Medical Science, Shiga, Japan
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, 13051Shiga University of Medical Science, Shiga, Japan
| | - Shigeyuki Naka
- Department of Research and Development for Innovative Medical Devices and Systems, 13051Shiga University of Medical Science, Shiga, Japan
- Department of Surgery, 84164Hino Memorial Hospital, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Division of Pathology, 13051Shiga University of Medical Science, Shiga, Japan
| | - Tohru Tani
- Department of Research and Development for Innovative Medical Devices and Systems, 13051Shiga University of Medical Science, Shiga, Japan
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12
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D’Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "To Be or Not to Be Benign" at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients. Diseases 2023; 11:diseases11010027. [PMID: 36810541 PMCID: PMC9945135 DOI: 10.3390/diseases11010027] [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: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9-79 years (average: 60.9 years). The tumor size range was 1.5-7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D’Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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13
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Peng C, Shen H, Cao S, Wu S, Huang Q, Li S, Li H, Zhang X, Wang B, Cao J, Ma X. Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison. J Endourol 2023; 37:28-34. [PMID: 36106602 DOI: 10.1089/end.2022.0233] [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] [Indexed: 01/10/2023] Open
Abstract
Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001). Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding. Clinical Trial Registry: Registration number: ChiCTR2000038291.
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Affiliation(s)
- Cheng Peng
- Medical School of Chinese PLA, Beijing, China.,Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Hao Shen
- Department of Anesthesiology, The First Medical Centre of PLA General Hospital, Beijing, China
| | - Senming Cao
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Shengpan Wu
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Qingbo Huang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Shichao Li
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Centre of PLA General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
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14
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Kotov SV, Nemenov AA, Yusufov AG, Guspanov RI, Pulbere SA, Nemenova DM. [Mean features of the nephron- sparing surgery in older patients with localized renal cell carcinoma]. Urologiia 2022:84-88. [PMID: 36625619] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients. OBJECTIVE To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients MATERIALS AND METHODS: From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula. RESULTS Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients from 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4-66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months. CONCLUSION Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.
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Affiliation(s)
- S V Kotov
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A A Nemenov
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A G Yusufov
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - R I Guspanov
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - S A Pulbere
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - D M Nemenova
- Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.,N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia.,S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
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15
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Ohba K, Matsuo T, Mitsunari K, Nakamura Y, Nakanishi H, Mochizuki Y, Miyata Y. Preservation of Split Renal Function After Laparoscopic and Robot-assisted Partial Nephrectomy. Anticancer Res 2022; 42:3055-3060. [PMID: 35641274 DOI: 10.21873/anticanres.15792] [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: 03/09/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To analyze the effects of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for the treatment of renal cell carcinoma (RCC) on subsequent split renal function using renal scintigraphy. PATIENTS AND METHODS We retrospectively analyzed data from 174 patients who underwent LPN or RAPN by a single surgeon, and assessed their total and split renal function before and 6 months after each procedure. Split renal function was analyzed using 99mTc-2,3 dimercaptosuccinic acid renal imaging and calculated as the total estimated glomerular filtration rate (eGFR) × uptake ratio on the surgical side/uptake ratio on the contralateral side. RESULTS LPN or RAPN were performed in 51 (29.3%) and 123 (70.7%) participants, respectively. Their median eGFRs before and after surgery were 32.76 and 27.74 ml/min/1.73 m2, respectively, and 70 of them (40.2%) showed a preservation of split eGFR of >90%, which was used to define a successful procedure. Participants who underwent a successful procedure had significantly lower RENAL nephrometry scoring system (RNS) scores and fewer of them had external tumors. Successful procedures were associated with shorter warm ischemia time, were more likely to be RAPN, and less likely to involve parenchymal suturing. Multivariate analysis showed that a low RNS score and parenchymal suturing were significant independent predictors of split renal function following partial nephrectomy (PN). CONCLUSION Preoperative RNS score and the use of parenchymal suturing are significantly associated with a preservation of split renal function of >90% in patients who undergo PN for the treatment of RCC.
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Affiliation(s)
- Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomohiro Matsuo
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Kensuke Mitsunari
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuichiro Nakamura
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiromi Nakanishi
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasushi Mochizuki
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Yasuyoshi Miyata
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
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16
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Kawase K, Enomoto T, Kawase M, Takai M, Kato D, Fujimoto S, Iinuma K, Nakane K, Kato S, Hagiwara N, Uno M, Koie T. The Impact of Postoperative Renal Function Recovery after Laparoscopic and Robot-Assisted Partial Nephrectomy in Patients with Renal Cell Carcinoma. Medicina (Kaunas) 2022; 58. [PMID: 35454324 DOI: 10.3390/medicina58040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
Background and objectives: This study aimed to evaluate the association between warm ischemic time (WIT) and postoperative renal function using Trifecta achievement in patients with renal cell carcinoma (RCC) who underwent robotic (RAPN) or laparoscopic partial nephrectomy (LPN). Materials and Methods: We conducted a retrospective multicenter cohort study of patients with RCC who underwent RAPN (RAPN group) or LPN (LPN group) at three institutions in Japan between March 2012 and October 2021. The primary endpoints were the rate of trifecta achievement in both surgical techniques and the association between WIT and recovery of postoperative renal function surgical outcomes. Results: The rate of trifecta achievement was significantly lower in patients with LPN than in those with RAPN (p < 0.001). WIT ≥ 25 min were 18 patients (18%) in the RAPN group and 89 (52.7%) in the LPN group. The postoperative estimated glomerular filtration rate (eGFR) was almost the same. However, 13 patients (7.7%) had a decreased in eGFR ≥ 15% at 3 months after LPN compared with the preoperative eGFR. Conclusions: The rate of trifecta achievement in the RAPN group was significantly higher than that in the LPN group. However, eGFR was identified as relatively better preserved after PN in both groups.
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17
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Yu Y, Wang W, Xiong Z, Yang Z, Li J, Shen Y, Gu B. Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score. Cancer Manag Res 2021; 13:7455-7461. [PMID: 34611439 PMCID: PMC8487266 DOI: 10.2147/cmar.s324457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aimed to compare perioperative outcomes of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) from a retrospective single-center dataset. Patients and Methods A retrospective single-center analysis of 210 patients who underwent open (n=91) or laparoscopic (n =119) partial nephrectomy for RCC was conducted between 2012 and 2015. All patients were grouped into low complexity, moderate complexity, and high complexity according to the R.E.N.A.L. Nephrometry Score, respectively. The rates of intraoperative and postoperative complications estimated blood loss, warm ischemia time, operative time, conversion of laparoscopic procedure to open surgery, and postoperative length of stay were assessed for both procedures. Results In low complexity group (n=93), patients undergoing LPN (n=52) under ischemia conditions had significantly longer renal artery clamp time (p < 0.001) and operative time (p = 0.001) compared with OPN (n=41). However, patients undergoing LPN had a significantly less postoperative length of stay (p=0.005) and estimated blood loss (p < 0.001) compared with OPN. There was no statistically significant difference in the rates of complications between LPN and OPN. In the moderate complexity group (n=114), 67 and 47 patients underwent LPN and OPN, respectively. LPN had notably longer warm ischemia time (p < 0.001) and operative time (p < 0.001) compared with OPN. There were no statistically significant differences in the rates of complications, estimated blood loss, and postoperative length of stay between LPN and OPN. In the high complexity group (n=3), all patients underwent OPN. Conclusion OPN and LPN procedures performed in patients with low and moderate complexity tumors based on the RENAL Nephrometry score offer acceptable and comparable results. When applied to low complexity tumors, our data suggest that laparoscopic NSS is an effective, minimally invasive therapeutic approach with the advantages of less blood loss, earlier hospital discharge, and more rapid convalescence.
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Affiliation(s)
- Yang Yu
- Urology Department, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wenfeng Wang
- Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China
| | - Zuquan Xiong
- Urology Department, Shanghai Huashan Hospital, Shanghai, People's Republic of China
| | - Zhenyu Yang
- Urology Department, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Jun Li
- Urology Department, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Yifan Shen
- Urology Department, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Bin Gu
- Urology Department, Shanghai Pudong New Area People's Hospital, Shanghai, People's Republic of China
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18
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Ueda T, Morinaga Y, Inoue K, Hirano S, Matsubara H, Hongo F. Juxtaglomerular cell tumor diagnosed preoperatively by renal tumor biopsy. IJU Case Rep 2021; 4:207-209. [PMID: 34258528 PMCID: PMC8255282 DOI: 10.1002/iju5.12283] [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: 12/08/2020] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diagnosis of small renal tumor from imaging analysis is limited. We report a case of juxtaglomerular cell tumor diagnosed preoperatively by renal tumor biopsy. CASE PRESENTATION A 17-year-old male was urgently hospitalized for acute-onset congestive heart failure. Radiographic findings revealed a 2-cm mass lesion, and on renal biopsy, a juxtaglomerular cell tumor was suspected. The juxtaglomerular cell tumor was resected by laparoscopic partial nephrectomy, on suspicion of causing the heart failure. The patient's clinical symptoms improved drastically postoperatively. CONCLUSION Biopsy may be a promising option for preoperative diagnosis of juxtaglomerular cell tumors.
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Affiliation(s)
- Takashi Ueda
- Department ofUrologyKyoto Prefectural University of MedicineKyoto‐CityKyotoJapan
| | - Yukiko Morinaga
- Department ofPathologyKyoto Prefectural University of MedicineKyoto‐CityKyotoJapan
| | - Kai Inoue
- Department of UrologyKyoto Yamashiro General Medical CenterKizugawa‐CityKyotoJapan
| | - Sojiro Hirano
- Department of UrologyKyoto Yamashiro General Medical CenterKizugawa‐CityKyotoJapan
| | - Hiroki Matsubara
- Department of UrologyKyoto Yamashiro General Medical CenterKizugawa‐CityKyotoJapan
| | - Fumiya Hongo
- Department ofUrologyKyoto Prefectural University of MedicineKyoto‐CityKyotoJapan
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19
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Plekhanova OA, Mono P, Martov AG, Golubev MY, Grigoriev NA, Kyzlasov PS, Abdullaev DA. [Comparative analysis of clinical features of robotic-assisted and laparoscopic partial nephrectomy]. Urologiia 2021:92-97. [PMID: 34251108] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Kidney cancer (mostly renal cell carcinoma) is one of the ten most commonly diagnosed malignant tumors among men and women. Due to the widespread use of computer tomography and magnetic resonance imaging, the proportion of early-stage kidney cancers has increased. Currently, treatment options for stage 1 kidney cancer are radical nephrectomy, partial nephrectomy, and active surveillance. Among organ-preserving intervention, three main techniques can be distinguished: open surgery, minimally invasive surgery and ablation methods. To date, robotic-assisted procedures have occupied their place among minimally invasive interventions. AIM To carry out a comparative analysis of two methods of organ-preserving treatment of kidney tumors, namely robot-assisted and laparoscopic partial nephrectomy. MATERIALS AND METHODS A retrospective comparative analysis of two groups of patients with kidney tumors who underwent robotic-assisted or laparoscopic partial nephrectomy during the period from 2012 to 2019 was performed. RESULTS There were no differences between two groups in age, mean score on the RENAL nephrometry scale, preoperative creatinine levels, tumor size, and duration of warm ischemia. However, duration of surgery, the volume of blood loss, serum creatinine after surgery, the length of stay, the use of the technique of early unclamping of the renal artery, the use of technique "off-clamp" and the proportion of exophytic tumors with growth were significantly different between patients of two groups. CONCLUSION We believe that the robotic system is intuitively convenient for performing partial nephrectomy, allowing the treatment of potentially more complex cases and expanding the indications for organ-preserving procedures.
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Affiliation(s)
- O A Plekhanova
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- AO European Medical Center", Moscow, Russia
| | - P Mono
- AO Ilyin Clinic, Krasnogorsk, Russia
| | - A G Martov
- Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
| | - M Yu Golubev
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
| | | | - P S Kyzlasov
- Center of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Krasnogorsk, Russia
| | - D A Abdullaev
- GBUZ City clinical hospital named after D.D. Pletnev of the Health Department c. Moscow, Moscow, Russia
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20
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Sands KG, Bhatt R, Vetter J, Paradis A, Chow AK, Bhayani S, Figenshau RS, Venkatesh R. Racial Comparison of Patients Undergoing Minimally Invasive Partial Nephrectomy for Renal Masses at a Large Volume Tertiary Center. J Endourol 2021; 35:1365-1371. [PMID: 33730861 DOI: 10.1089/end.2020.0655] [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] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objective: African American (AA) race has been identified to have a higher incidence of chronic kidney disease (CKD) and worse renal cancer survival compared with Caucasian Americans (CA), irrespective of tumor size, pathologic type, and surgical procedure. We aimed to compare the outcomes between CA and AA patients undergoing minimally invasive partial nephrectomy (PN) at our high-volume center. Materials and Methods: We queried our PN data repository from 2007 to 2017. We identified 981 cases of PN (robotic n = 943 and laparoscopic n = 38), of which there were 852 CA and 129 AA patients. We compared age, sex, body mass index (BMI), operative time, estimated blood loss (EBL), nephrometry score, tumor size, pre- and postoperative estimated glomerular filtration rate (eGFR), length of stay, Charlson Comorbidity Index (CCI), tumor characteristics, and 30-day complication rate. We then estimated the overall survival and disease-specific survival. Results: Age, BMI, operative time, EBL, nephrometry score, tumor size, CCI, length of stay, and sex were not statistically different. The mean preoperative eGFR was higher in the AA cohort (91.4 mL/min/1.73 m2 vs 86.1 mL/min/1.73 m2, p = 0.007); however, at 1 year, there was no mean difference (76.8 mL/min/1.73 m2 vs 74.5 mL/min/1.73 m2, p = 0.428). There was a higher percentage of Fuhrman Grade 3/4 in the AA cohort (33.3% vs 22.5%, p = 0.044). The AA cohort had a 2.66 × higher incidence of papillary renal cell carcinoma (RCC) (34.9% vs 13.1%, p < 0.001) and unclassified RCC (3.9% vs 0.4%, p = 0.001). There was no difference in tumor stage (p = 0.260) or incidence of benign histology (15.3% vs 11.6%, p = 0.278). There were no differences in 30-day complications (p = 0.330). The median follow-up was 43.2 months. By using Kaplan-Meier curves, there was no observed difference in overall survival (p = 0.752) or disease-free survival (p = 0.403). Conclusions: Our cohort of AA and CA patients with intermediate follow-up showed no worse outcomes for CKD or survival when undergoing laparoscopic or robotic PN. For low-stage renal cancer, there was no difference in overall survival and disease-free survival at a median follow-up of 43.2 months among AA patients, despite having higher grade tumors and a higher percentage of unclassified RCC. Our cohort of AA patients did have a higher incidence of papillary RCC. The equivalent overall survival and disease-free survival could be due to the earlier discovery of lower stage renal masses incidentally identified on imaging studies performed equally for other reasons in both AA and CA patients.
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Affiliation(s)
- Kenneth G Sands
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rohit Bhatt
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alethea Paradis
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alexander K Chow
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sam Bhayani
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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21
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Abstract
Renal cell carcinoma has historically been managed by radical nephrectomy, but as knowledge of the disease has advanced, nephron sparing surgery has become the norm in appropriately selected tumors. Laparoscopic partial nephrectomy (LPN) has been shown to have comparable oncologic outcomes and a shorter convalescence period compared to the traditional open partial nephrectomy. Dissemination of techniques has led to significantly increased use of minimally invasive nephron sparing surgery, and LPN remains a cost-effective and efficacious method for approaching small renal masses.
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Affiliation(s)
- Sandeep Gurram
- The Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
| | - Louis Kavoussi
- The Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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Ye Z, Fan H, Tong A, Xiao Y, Zhang Y. The Small Size and Superficial Location Suggest That Laparoscopic Partial Nephrectomy Is the First Choice for the Treatment of Juxtaglomerular Cell Tumors. Front Endocrinol (Lausanne) 2021; 12:646649. [PMID: 33995279 PMCID: PMC8120284 DOI: 10.3389/fendo.2021.646649] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juxtaglomerular cell tumor (JGCT) is a very rare disease, and surgical resection is the only possible way to cure this tumor. Open nephrectomy and partial nephrectomy have been reported to manage JGCTs with excellent results in the previous reviews. Laparoscopic surgery has been popularized in recent years, while critical issues associated with laparoscopic surgical management have been seldom reported. We summarized the JGCTs in our center to discover the optimal surgical management and its anatomic foundation. METHODS In this retrospective study, we enrolled a total of 14 JGCT patients. All patients received surgeries and were followed up for up to 11 years. We mainly summarized the size and location of tumors, imaging features, and surgical strategies. A descriptive statistical analysis was performed. RESULTS The JGCTs in this study had a median size of 1.35 cm and all located superficially, mainly in the cortical or subcortical area of the kidney. All 14 patients had hypertension, ten had hypokalemia, and seven had elevated plasma renin activity. Pathologically, JGCT cells were polygonal or spindle shape, with positive CD34 and vimentin immunostaining. All patients received partial nephrectomy; nine were laparoscopic, and five were open. Laparoscopic partial nephrectomy (LPN) was performed in seven out of eight patients over the last nine years. Postoperative blood pressure, serum potassium, and plasma renin activity were normal in all patients. No recurrence occurred within a median follow-up of 60 months. CONCLUSION The small size and superficial location are the characteristic anatomic features of JGCT; they suggest that LPN is the preferred surgical strategy. Laparoscopic ultrasound is helpful for the intraoperative detection of small JGCTs. Longer follow-up is required to examine the biological behavior of JGCTs and the effect of LPN.
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Affiliation(s)
- Zixing Ye
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Hua Fan
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Yushi Zhang,
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Artykov M, Haberal HB, Kahraman O, Gudeloglu A, Yazici S, Bilen CY. Comparison of clamping strategies in minimally invasive partial nephrectomy for cT1 tumors. MINIM INVASIV THER 2020; 31:609-614. [PMID: 33155497 DOI: 10.1080/13645706.2020.1840397] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques. MATERIAL AND METHODS We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results. RESULTS The mean patient age and median follow-up period were 56.8 ± 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group (p = .726, p = .604, p = .675, p = .103, and p = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively (p = .001 and p = .044, respectively) and at the last follow-up (p = .020 and p = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant (p = .056 and p = .082, respectively). CONCLUSIONS Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.
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Affiliation(s)
- Meylis Artykov
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Oguzhan Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sertac Yazici
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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24
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Jiang Y, Zeng H, Zhu Z, Chen J, Chen H. Three-Dimensional Printing Assisted Laparoscopic Partial Nephrectomy vs. Conventional Nephrectomy in Patients With Complex Renal Tumor: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:551985. [PMID: 33194610 PMCID: PMC7643019 DOI: 10.3389/fonc.2020.551985] [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: 04/16/2020] [Accepted: 08/27/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: The purpose of this meta-analysis was to systematically assess the influence of three-dimensional (3D) printing technology in laparoscopic partial nephrectomy (LPN) of complex renal tumors. Methods: A systematic literature review was performed in June 2020 using the Web of Science, PubMed, Embase, the Cochrane library, the China National Knowledge Infrastructure (CNKI), and the Wanfang Databases to identify relevant studies. The data relative to operation time, warm ischemic time, intraoperative blood loss, positive surgical margin, reduction in estimated glomerular filtration rate (eGFR), and complications (including artery embolization, hematoma, urinary fistula, transfusion, hematuria, intraoperative bleeding, and fever) were extracted. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the Stata 12.1 software. A subgroup analysis was performed stratifying patients according to the complexity of the tumor and surgery type or to the nephrometry score. Results: One randomized controlled trial (RCT), two prospective controlled studies (PCS), and seven retrospective comparative studies (RCS) were analyzed, involving a total of 647 patients. Our meta-analysis showed that there were significant differences in operation time, warm ischemic time, intraoperative blood loss, reduction in eGFR, and complications between the LPN with 3D-preoperative assessment (LPN-3DPA) vs. LPN with conventional 2D preoperative assessment (LPN-C2DPA) groups. Positive surgical margin did not differ significantly. Conclusion: The LPN-3DPA group showed shorter operation time and warm ischemic time, as well as less intraoperative blood loss, reduction in eGFR, fewer complications for patients with complex renal tumor. Therefore, LPN assisted by three-dimensional printing technology should be a preferable treatment of complex renal tumor when compared with conventional LPN. However, further large-scale RCTs are needed in the future to confirm these findings.
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Affiliation(s)
| | | | | | - Jinbo Chen
- Xiangya Hospital, Central South University, Changsha, China
| | - Hequn Chen
- Xiangya Hospital, Central South University, Changsha, China
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25
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Dong J, Zhao Y, Xu W. Case Report: Retroperitoneal Laparoscopic Partial Nephrectomy for T2 Renal Cell Carcinoma During Pregnancy. Front Oncol 2020; 10:552228. [PMID: 33163398 PMCID: PMC7591673 DOI: 10.3389/fonc.2020.552228] [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: 04/15/2020] [Accepted: 08/21/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: Renal cell carcinoma (RCC) found during pregnancy is rare. Treatment strategies and timing of surgeries are controversial. Retroperitoneal laparoscopic partial nephrectomy for T2 RCC during pregnancy has not been reported before. Patient Concerns and Diagnosis: Herein, we report a case of T2 RCC found in a 36-year-old woman during her 21st week of pregnancy. Both ultrasound and magnetic resonance imaging (MRI) suggested a malignancy, possibly renal cell carcinoma. Interventions and Outcomes: After discussion with a multidisciplinary team, the tumor was removed completely via retroperitoneal laparoscopic partial nephrectomy, and pathology result was clear cell RCC. A male infant was delivered full-term uneventful, and both the patient and the boy were in good health after a 46-month follow-up. Conclusion: Partial nephrectomy with retroperitoneal laparoscopic technique is feasible and recommended in some T2 RCC patients.
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Affiliation(s)
- Jie Dong
- Urology Department of Peking Union Medical College Hospital, Beijing, China
| | - Yi Zhao
- Urology Department of Peking Union Medical College Hospital, Beijing, China
| | - Weifeng Xu
- Urology Department of Peking Union Medical College Hospital, Beijing, China
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26
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Yoshida T, Okinaka Y, Tomita K, Tsuru T, Kageyama S, Narita M, Kawauchi A. Off-clamp tumor excision using soft coagulation in laparoscopic and robotic partial nephrectomy. Asian J Endosc Surg 2020; 13:519-525. [PMID: 31908133 DOI: 10.1111/ases.12775] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/18/2019] [Accepted: 11/13/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of this study was to assess the perioperative outcomes of off-clamp tumor excision using soft coagulation in laparoscopic and robotic partial nephrectomy. METHODS We retrospectively analyzed the data from 78 patients who underwent minimally invasive partial nephrectomy, using soft coagulation, at the Shiga University of Medical Science, between September 2013 and April 2017. Tumor excision and hemostasis without renal arterial clamping was performed using soft coagulation. Collecting system repair and renorrhaphy with arterial clamping were carried out only if the collecting system had been opened. RESULTS Forty-three of the 78 patients underwent laparoscopic partial nephrectomy using soft coagulation and the other 35 patients underwent robotic partial nephrectomy using soft coagulation. The median estimated total blood loss was 73 (0-1140) mL and no patient needed a blood transfusion. No cases featured postoperative hemorrhagic events. Six patients with urinary fistula needed prolonged ureteral stenting. The median percentage change of the estimated glomerular filtration rate was -7.2 at one to 3 months after surgery. CONCLUSION The off-clamp soft coagulation technique in laparoscopic partial nephrectomy and robotic partial nephrectomy is a safe and feasible approach to excise kidney tumors. This procedure may reduce the incidence of perioperative hemorrhagic complications.
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Affiliation(s)
- Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Yuki Okinaka
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Keiji Tomita
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Teruhiko Tsuru
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Mitsuhiro Narita
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
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Takeda T, Komatsuda A, Yanai Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Shinojima T, Asanuma H, Oya M. Factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy for clinical T1a renal masses. Asian J Endosc Surg 2020; 13:526-531. [PMID: 31814326 DOI: 10.1111/ases.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/14/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The goal of partial nephrectomy for renal tumors is complete tumor removal with the preservation of renal function and no complications. Trifecta (total ischemia time < 25 minutes, negative surgical margins, and no surgical complications) is widely used to evaluate success after partial nephrectomy. We investigated factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. METHODS Sixty-six patients who underwent laparoscopic partial nephrectomy for clinical T1a renal masses between December 2006 and March 2016 were examined. We defined preserved renal function as the preservation of an estimated glomerular filtration rate ≥ 90% 1 year after surgery. We examined factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. RESULTS Thirty out of 66 patients (45%) did not achieve trifecta. In an evaluation of 66 patients, a multivariate analysis identified tumor size (P = .04) as an independent predictor affecting the achievement of trifecta. Tumor size was significantly smaller in the trifecta achievement group (1.9 ± 0.1 cm) than in the non-achievement group (2.2 ± 0.6 cm) (P = .04). We found that renal function was preserved 1 year after surgery in 14 out of the 30 patients not achieving trifecta. In univariate analysis, age (P = .01) was significantly associated with affecting the preservation of renal function among these patients. Patients with preserved renal function were significantly younger (47.8 ± 2.5 years) than those without (58.5 ± 2.9 years) (P = .01). CONCLUSION Renal function may be preserved in younger patients even if they do not achieve trifecta after partial nephrectomy for small renal masses.
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Affiliation(s)
- Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akari Komatsuda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Yanai
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Shinya Morita
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Larcher A, Wallis CJ, Pavan N, Porpiglia F, Takagi T, Tanabe K, Rha KH, Raheem AA, Yang B, Zang C, Perdonà S, Quarto G, Maurer T, Amiel T, Schips L, Castellucci R, Crivellaro S, Dobbs R, Baiamonte G, Celia A, De Concilio B, Furlan M, Lima E, Linares E, Micali S, Amparore D, De Naeyer G, Trombetta C, Hampton LJ, Tracey A, Bindayi A, Antonelli A, Derweesh I, Mir C, Montorsi F, Mottrie A, Autorino R, Capitanio U. Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database. Cent European J Urol 2020; 73:273-279. [PMID: 33133653 PMCID: PMC7587491 DOI: 10.5173/ceju.2020.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/17/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Toshio Takagi
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Women's Medical University, Tokyo, Japan
| | - Koon H. Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology, Tanta University, Tanta, Egypt; Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bo Yang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Chao Zang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Sisto Perdonà
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Giuseppe Quarto
- Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy
| | - Tobias Maurer
- Department of Urology, Technical University, Munich, Germany
| | - Thomas Amiel
- Department of Urology, Technical University, Munich, Germany
| | - Luigi Schips
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Roberto Castellucci
- Department Of Urology, Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Gianfranco Baiamonte
- Unit of Urology, 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, Italy
| | | | - Maria Furlan
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Estevão Lima
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | | | - Salvatore Micali
- University of Modena and Reggio Emilia, Department of Urology, Modena, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
| | | | | | - Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital University of Brescia, Brescia, Italy
| | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Carme Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Würnschimmel C, Di Pierro GB, Moschini M, Grande P, Baumeister P, Roth M, Mordasini L, Mattei A. Robot-Assisted Laparoscopic Partial Nephrectomy Vs Conventional Laparoscopic Partial Nephrectomy: Functional and Surgical Outcomes of a Prospective Single Surgeon Randomized Study. J Endourol 2020; 34:847-855. [PMID: 32486864 DOI: 10.1089/end.2020.0143] [Citation(s) in RCA: 3] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. Objective: To compare functional and surgical outcomes of LPN and RAPN. Patients and Methods: Between 2015 and 2019, we prospectively randomized 115 patients with cT1-T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. Results: One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was -18.0% (-26.5 to -11.0) in LPN group and -20.0 (-33.2 to -12.0) in RAPN group (p = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group (p = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% (n = 3); p = 0.099. Renal volume loss after 6 months was 27.5% (22.7-45.7) in the LPN group vs 37.5 (13.7-54.2) in the RAPN group (p = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] vs 230.2 minutes [SD 59.6], p = 0.001). More complications occurred in the LPN group (31% vs 21%, p = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. Conclusions: In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach.
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Affiliation(s)
| | | | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Pietro Grande
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Manuel Roth
- Klinik für Radiologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland
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30
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Zhou C, Xu L, Xu Z, Ge Y, Zhou L, Wang F, Liu J, Pan G, Yang T, Jia R. Pneumoperitoneum preconditioning for the prevention of renal function after laparoscopic partial nephrectomy: protocol for a double-blind randomised controlled trial. BMJ Open 2020; 10:e032002. [PMID: 32461289 PMCID: PMC7259839 DOI: 10.1136/bmjopen-2019-032002] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Renal ischaemia reperfusion injury is an inevitable pathophysiology in different clinical situations including laparoscopic partial nephrectomy (LPN), which can obviously decrease the renal function after surgery. Pneumoperitoneum preconditioning (PP) is a promising approach that can yield a protective effect on kidney, which has already been demonstrated in some animal models. The present study is designed to assess whether the PP can yield a clinical renoprotective role after LPN. METHODS AND ANALYSIS This study is a randomised, prospective, double-blind and parallel controlled clinical trial. Eligible participants will be patients with renal tumours and willing to choose elective LPN. Patients randomised to the treatment arm will receive PP consisted of three cycles of 5 min insufflation and 5 min desufflation before LPN, while the control arm will receive a sham operation. The primary endpoints are glomerular filtration rate and the level of serum cystatin C within 6 months after desufflation. The secondary endpoints are serum creatinine, estimated glomerular filtration rate, alanine transaminase, serum amylase, intestinal fatty acid binding protein, postoperative hospital stay, the incidence of adverse events and mortality in postoperative 6 months. ETHICS AND DISSEMINATION This study has been approved by the institutional ethics committee of Nanjing First Hospital. The results of this study will be reported faithfully through scientific conferences or published articles. TRIAL REGISTRATION NUMBER NCT03822338.
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Affiliation(s)
- Changcheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Luwei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Yuzheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Liuhua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Feng Wang
- Nuclear Medicine Center, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Jingyu Liu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Gaojian Pan
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Tianli Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
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31
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Pacheco M, Barros AA, Aroso IM, Autorino R, Lima E, Silva JM, Reis RL. Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective. J Biomed Mater Res B Appl Biomater 2020; 108:3099-3123. [PMID: 32458570 DOI: 10.1002/jbm.b.34637] [Citation(s) in RCA: 8] [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: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.
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Affiliation(s)
- Margarida Pacheco
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre A Barros
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ivo M Aroso
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Estêvão Lima
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Joana M Silva
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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32
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Dubrovin V, Egoshin A, Rozhentsov A, Batuhtin D, Eruslanov R, Chernishov D, Furman Y, Baev A. Virtual simulation, preoperative planning and intraoperative navigation during laparoscopic partial nephrectomy. Cent European J Urol 2019; 72:247-251. [PMID: 31720025 PMCID: PMC6830493 DOI: 10.5173/ceju.2019.1632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/28/2017] [Revised: 02/18/2018] [Accepted: 04/23/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction The use of computer navigation systems is a new and actively explored method used for surgical procedures concerning the abdominal and retroperitoneal organs. In this paper, we propose an original hardware – software complex, which forms a virtual body model, based on preoperative computer tomography data, transmitted to the operating screen monitor using a surgical navigation system, involving a mechanical digitizer. Material and methods During a laparoscopic procedure, a three-dimensional (3D) model of a kidney with a tumor was used to obtain additional information on the primary or secondary monitor or for combining the virtual model and video images on the main or additional monitor in the operating room. This method was used for laparoscopic partial nephrectomy, where twelve patients were operated with an average age of 45.4 (38–54) years, with clear cell renal cell carcinoma size 27.08 (15–40) mm. Results All patients successfully underwent laparoscopic partial nephrectomy with intraoperative navigation. The mean operative time was 97.2 (80–155) minutes, warm ischemia time – 18.0 (12–25) minutes. Selective clamping of segmental renal arteries was performed in 7 (58.3%) cases, in the remaining 5 (41.6%) cases the renal artery was clamped. There were no serious complications. The average duration of hospital stay was 7.0 (5–10) days. Conclusions Preliminary results of our clinical study have shown the success of 3D modeling for qualitative visualization of kidney tumors in the course of surgical intervention, both for the surgeon and for the patient to understand the nature of the pathological process.
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Affiliation(s)
| | | | - Alexey Rozhentsov
- Volga State University of Technology, Yoshkar-Ola, Russian Federation
| | - Dmitrii Batuhtin
- Volga State University of Technology, Yoshkar-Ola, Russian Federation
| | - Ruslan Eruslanov
- Volga State University of Technology, Yoshkar-Ola, Russian Federation
| | | | - Yacov Furman
- Volga State University of Technology, Yoshkar-Ola, Russian Federation
| | - Alexey Baev
- Volga State University of Technology, Yoshkar-Ola, Russian Federation
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33
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Tanaka M, Irie S, Nakagawa K, Nishimatsu H, Inokuchi J, Eto M. Nonischemic or Ischemic Laparoscopic Partial Nephrectomy Using a Newly Developed Hybrid Energy Device in a Porcine Model. J Endourol 2019; 34:82-87. [PMID: 31507214 DOI: 10.1089/end.2019.0435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To compare the efficacy of a newly developed hybrid pencil-type energy device (HD) generating simultaneously monopolar high-frequency electric energy and ultrasonic energy with that of a conventional device (CD) during laparoscopic partial nephrectomy (LPN). Materials and Methods: A total of 16 female pigs (32 kidneys) were divided into 4 groups of 4 animals (8 kidneys) each: nonischemic and ischemic HD-LPN groups, and nonischemic and ischemic CD-LPN groups. We performed bilateral LPN for each pig. HD alone was used in the HD-LPN group, whereas commercially available monopolar scissors and a soft coagulation system were used in the CD-LPN group. After observing the postoperative course for 14 days, we euthanized the animals and harvested the kidneys for histopathological observations. Results: We completed an LPN on a total of 32 kidneys. There were no cases of conversion to open surgery, nor were there any deaths or complications requiring treatment. For nonischemic LPN, LPN time was significantly shorter in the HD-LPN group than in the CD-LPN group (11.4 ± 4.8 vs 17.7 ± 5.3 minutes, p = 0.027). The decrease in postoperative hemoglobin was equally low in both groups. However, the frequency of TachoSil® use was significantly higher in the CD-LPN group than in the HD-LPN group (6/8 [75%] vs 0/8 [0%], p = 0.007). For ischemic LPN, we found no significant differences in parameters such as LPN time and using TachoSil between the two groups. The depth of thermal injury was the most superficial in the nonischemic HD-LPN group in comparison with the other three groups. Conclusions: The application of an HD allowed nonischemic LPN to be performed safely in a short time with less blood loss and less thermal injury to the kidney in the porcine model. Additional clinical investigations of human kidneys are required.
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Affiliation(s)
- Masatoshi Tanaka
- Department of Urology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinichiro Irie
- Department of Urology, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ken Nakagawa
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | | | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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34
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Fan G, Meng Y, Zhu S, Ye M, Li M, Li F, Ye Y, Liu Z, Weiqin H, Xie Y. Three-dimensional printing for laparoscopic partial nephrectomy in patients with renal tumors. J Int Med Res 2019; 47:4324-4332. [PMID: 31327282 PMCID: PMC6753553 DOI: 10.1177/0300060519862058] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objectives To explore the efficacy of three-dimensional printing physical model-assisted
laparoscopic partial nephrectomy (3D-LPN) in patients with renal tumors. Methods We retrospectively assessed all patients who underwent LPN with or without
3D-printed physical model assistance from January 2016 to February 2018 at
our institution. The demographic characteristics, operative findings, and
clinical outcomes from the procedure were collected and analyzed. Results Sixty-nine patients underwent 3D-LPN and 58 underwent traditional LPN. The
groups showed no differences in demographics, RENAL score, surgical
approach, operative time, estimated intra-/postoperative blood loss,
increased creatinine level, or complications. In the 3D-LPN group, warm
ischemia time was shorter, whereas surgery waiting time was longer, compared
with those parameters in the LPN group. Subgroup analysis indicated that for
patients with RENAL score ≥8, the 3D-LPN group had significantly shorter
warm ischemic time and less intraoperative blood loss than the traditional
LPN group. Intra- and postoperative hospital complication rates were similar
for 3D-LPN and traditional LPN groups (8.7% vs. 13.7%). Conclusions 3D printing provides an additional tool to assist with LPN. Use of a 3D model
can assist in planning and performance of LPN in patients with RENAL score
≥8.
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Affiliation(s)
- Gang Fan
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yanbin Meng
- Department of Human Anatomy, Xiangnan University, Chenzhou,
China
| | - Shuai Zhu
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Mingji Ye
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Mingfeng Li
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
- The First People's Hospital of Huaihua, Huaihua, China
| | - Feiping Li
- Radiology, Affiliated Cancer Hospital of Xiangya School of
Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yuanchun Ye
- Clinical Research Center and Department of Gastroenterology,
Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian,
China
| | - Zhizhong Liu
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Han Weiqin
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
| | - Yu Xie
- Department of Urology, Affiliated Cancer Hospital of Xiangya
School of Medicine of Central South University, Hunan Cancer Hospital, Changsha,
China
- Yu Xie, Department of Urology, the
Affiliated Cancer Hospital of Xiangya School of Medicine of Central South
University, Hunan Cancer Hospital, Changsha, Hunan 410013, China.
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35
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Zhan H, Huang C, Li T, Yang F, Cai J, Li W, Mao Y, Zhou X. The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis. Surg Innov 2019; 26:744-752. [PMID: 31215335 DOI: 10.1177/1553350619856167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT (P < .00001), shorter overall operative time (P < .00001), lower estimated blood loss (P = .02), and better renal function preservation (P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications (P = .08) and length of hospital stay (P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.
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Affiliation(s)
- Hailun Zhan
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | | | - Tengcheng Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fei Yang
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiarong Cai
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenbiao Li
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yunhua Mao
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangfu Zhou
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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36
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Crofton A, Baldwin D, Alsyouf M, Dopp M, Faaborg D, Myklak K, Arenas J, Khater N, Hudson S, Oberg KC, Kirsch WM. Evaluation of a Chitosan Hemostat in a Porcine Laparoscopic Partial Nephrectomy Model: A Pilot Study. J Endourol 2019; 33:887-894. [PMID: 31056929 DOI: 10.1089/end.2018.0801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and Objective: The ideal hemostatic agent for laparoscopic partial nephrectomy (LPN) would provide complete hemostasis and sealing of the collecting system at a low cost. Chitosan (CS) is an established topical hemostatic agent, but standard sterilization techniques affect its functional and biologic properties, thereby preventing parenteral uses. This study sought to characterize the safety and efficacy of an implanted CS hemostat sterilized with either a standard technique, electron beam (e-beam) irradiation, or a novel technique, nonthermal nitrogen plasma, in a porcine LPN model. Methods: Laparoscopic partial nephrectomies were performed on six farm pigs and hemostasis achieved using only a CS hemostatic agent (Clo-Sur P.A.D.) that was e-beam (n = 3) or plasma sterilized (PS) (n = 3). Number of pads needed to achieve hemostasis, estimated blood loss, operative time, mass of kidney resection, and warm ischemia time were measured. Animals were monitored for 14 weeks and at harvest, retrograde ureteropyelography and histologic analysis were performed. Results: Complete hemostasis and collection system sealing were achieved in both groups. There was a trend toward less pads required for hemostasis (p = 0.056) and reduced blood loss (p = 0.096) with PS pads, although this did not achieve statistical significance. No complications were observed for 14 weeks and gross examination showed the implanted CS was encapsulated in a fibrous capsule. Histologic analysis revealed a healed nephrectomy site with residual CS and associated chronic inflammation, reactive fibrosis, and foreign body giant cell formation. Importantly, the adjacent renal tissue was intact and viable with no residual parenchymal inflammation or cytologic damage. Conclusion: CS pads alone provided safe and effective hemostasis in a porcine LPN model. PS may enhance hemostatic efficacy and resorption compared with e-beam.
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Affiliation(s)
- Andrew Crofton
- Department of Anatomy, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, California.,Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, California
| | - Duane Baldwin
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Muhannad Alsyouf
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Matthew Dopp
- Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, California.,Department of Radiology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Daniel Faaborg
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Kristine Myklak
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Javier Arenas
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Nazih Khater
- Department of Urology, School of Medicine, Loma Linda University, Loma Linda, California.,Department of Urology, School of Medicine, Louisiana State University, Shreveport, Louisiana
| | - Samuel Hudson
- College of Textiles, North Carolina State University, Raleigh, North Carolina
| | - Kerby C Oberg
- Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, California
| | - Wolff M Kirsch
- Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, California.,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, California
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Çamlıdağ İ, Öner S, Özden E. Two-dimensional shear wave elastography of the perirenal fat: Can sticky fat be predicted? J Clin Ultrasound 2019; 47:201-205. [PMID: 30560576 DOI: 10.1002/jcu.22681] [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] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate whether two-dimensional (2D) shear wave elastography (SWE) can predict the presence of perirenal sticky fat (PSF) by showing increased perirenal fat stiffness. METHODS We prospectively enrolled 28 patients with 31 renal tumors and 10 donor cases. Conventional renal ultrasound (US) and 2D-SWE examination of the perirenal fat were performed. Patient age, gender, body mass index (BMI), largest mass size, PF shear wave velocity (SWV) on both sides were recorded. During surgery, presence of PSF and perirenal fat dissection time (PFDT) were recorded. RESULTS Twenty three renal masses were malignant and eight were benign. There were 13 clear cell carcinomas and 10 nonclear cell carcinomas. Eight patients had PSF. Mean PFDT was 13 minutes. PFDT and BMI were significantly increased in the PSF group (p < .05). No statistically significant differences were found in SWVs in patients with and without PSF. There were no significant differences with regard to SWVs between donor cases and patients, tumor side and nontumor side, benign masses and malignant masses, clear cell and nonclear cell tumors. No significant correlations were detected between SWVs and PFDT, mass size, Fuhrman grade and BMI (p > .05). CONCLUSION 2D-SWE cannot detect PSF.
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Affiliation(s)
- İlkay Çamlıdağ
- Department of Radiology, 55210 Kurupelit, Ondokuz Mayıs University, Samsun, Turkey
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38
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Mamedkasimov NA, Spot EV, Alyaev YG, Rapoport LM, Sorokin NI. [Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?]. Urologiia 2019:56-62. [PMID: 31184019] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.
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Affiliation(s)
- N A Mamedkasimov
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - E V Spot
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - Yu G Alyaev
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - L M Rapoport
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - N I Sorokin
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
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Savran Karadeniz M, Alp Enişte I, Şentürk Çiftçi H, Usta S, Tefik T, Şanlı Ö, Pembeci K, Tuğrul KM. Neutrophil Gelatinase-associated Lipocalin Significantly Correlates with Ischemic Damage in Patients Undergoing Laparoscopic Partial Nephrectomy. Balkan Med J 2019; 36:121-128. [PMID: 30417831 PMCID: PMC6409963 DOI: 10.4274/balkanmedj.galenos.2018.2018.0852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 12/13/2022] Open
Abstract
Background Laparoscopic partial nephrectomy, which minimizes renal function loss due to its nephron sparing nature, has become a standard technique among many experienced centers worldwide for surgical treatment of localized kidney tumors. Although partial nephrectomy will remain the gold standard, we need to improve perioperative management and surgical method to prevent postoperative acute kidney injury. Aims To demonstrate the frequency of the development of postoperative acute kidney injury following laparoscopic partial nephrectomy in patients with healthy contralateral kidney and determine the early predictive effects of serum neutrophil gelatinase-associated lipocalin on ischemia-reperfusion injury and its association with warm ischemia time. Study Design Cross-sectional study. Methods Eighty patients were included. We analyzed tumor size, operating time, duration of anesthesia, and warm ischemia time. Serum samples were obtained for measurement of serum creatinine, estimated glomerular filtration rate, and neutrophil gelatinase-associated lipocalin level preoperatively, at the postoperative 2nd hour, and on postoperative days 1 and 2. We used receiver operating characteristic curve for determining the cut-off point of neutrophil gelatinase-associated lipocalin to detect postoperative acute kidney injury. Correlation analysis was performed using Spearman’s test. Results Twenty-seven patients developed acute kidney injury on postoperative day 2, and the neutrophil gelatinase-associated lipocalin level increased significantly at the postoperative 2nd hour in the acute kidney injury group (p=0.048). For a cut-off of 129.375 ng/mL neutrophil gelatinase-associated lipocalin, the test showed 70.0% sensitivity and 68.3% specificity for the detection of acute kidney injury at the postoperative 2nd hour. For a cut-off of 184.300 ng/mL neutrophil gelatinase-associated lipocalin, the test exhibited 73.3% sensitivity and 63.3% specificity for the detection of acute kidney injury on postoperative day 1. A significant correlation was found between warm ischemia time and neutrophil gelatinase-associated lipocalin level at the postoperative 2nd hour (r=0.398, p=0.003). The creatinine values were significantly higher and the estimated glomerular filtration rates were significantly lower on postoperative days 1 and 2 in the acute kidney injury group compared with those in the non-acute kidney injury group (p<0.001). Conclusion The neutrophil gelatinase-associated lipocalin may be used as an alternative biomarker to serum creatinine in differentiation of ischemic damage in patients undergoing laparoscopic partial nephrectomy.
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Affiliation(s)
- Meltem Savran Karadeniz
- Department of Anesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Isbara Alp Enişte
- Clinic of Anesthesiology, Grup Florence Nightingale Hospital, İstanbul, Turkey
| | - Hayriye Şentürk Çiftçi
- Department of Medical Biology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Sebahat Usta
- Department of Medical Biology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Öner Şanlı
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Kamil Pembeci
- Department of Anesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Kamil Mehmet Tuğrul
- Department of Anesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Shpot EV, Mamedkasimov NA, Alyaev YG, Rapoport LM, Proskura AV, Mashin GA. [A comparative analysis of laparoscopic and retroperitoneoscopic partial nephrectomy depending on the type of temporary and definite hemostasis]. Urologiia 2018:95-100. [PMID: 30742385] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM to carry out a comparative analysis of treatment results of patients with renal tumors who were undergone to nephron-sparing surgery, depending on the type of temporary and definite hemostasis. MATERIALS AND METHODS a total of 163 laparoscopic partial nephrectomies were performed by single surgeon from January 2015 to July 2018. The comparative analysis of treatment results of patients with renal tumors based on following parameters: tumor stage, features of the tumor site, the duration of surgery, the amount of blood loss, complications rate and grade as well as functional and oncological outcomes, depending on the type of temporary and definite hemostasis, was conducted. For preoperative planning the generally accepted nephrometric scale R.E.N.A.L. was used as well as 3D-reconstruction of the tumor. RESULTS Of the 163 patients, 64 were women (39.3%). The mean age of patients was 56.7+/-11.1 (25-80 years). A clinical stage T1a, T1b, T2 and T3a was diagnosed in 77, 20, 2 and 64 cases, respectively. The average tumor size was 34.8+/-1.1 (11-78 mm). The mean operative time was 84.5+/-32.2 min (30-180). Laparoscopic transperitoneal access was used in 90 patients (55.21%), retroperitoneoscopic approach was chosen in 73 cases (44.79%). The tumor had exophytic growth in 110 cases (67.5%) and in 53 cases it was endophytic (32.5%), while in 59 cases it localized in renal sinus (36.2%). The operative time was significantly shorter in the Group of zero ischemia (72.2+/-29.02 [p<0.001]) and bipolar coagulation of the tumor bed (60.8+/-31.7 [p<0.001]). The mean volume of blood loss was 160.8+/-142.7 ml (30-900). A GFR calculated by the MDRD equation (mean level was 75.7 ml/min/1.73 m2) on the next day and 6 months after surgery showed a slight decrease in group of zero ischemia, compared to other groups: next day and 6 months after surgery it was 72.8+/-21.6 (p<0.001) and 72.01+/-16.6 (p=0.025), respectively. A simple enucleation was performed in 41 cases, while enucleoresection was done in 70 cases. A collection system was opened in 22 cases (13.5%+/-9.8). The suturing and clipping were performed in 20 and 2 patients, respectively. In 2 cases a stenting was performed. In 2 cases there was hemoglobin drop requiring blood transfusion (1.2%+/-3). An embolization due to refractory bleeding was required in 3 cases (1.8%+/-3.7). There was no conversion to open surgery or nephrectomy. Of the 163 tumors, a malignancy was diagnosed in 151 (92.6%+/-7.5) cases. There was no positive surgical margin and recurrence of the tumor. CONCLUSION Laparoscopic partial nephrectomy can be successfully performed under zero ischemia. The intervention without clamping of renal blood vessels contributes to significant preservation of the renal function.
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Affiliation(s)
- E V Shpot
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - N A Mamedkasimov
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - Yu G Alyaev
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - L M Rapoport
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - A V Proskura
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
| | - G A Mashin
- FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
- Clinic of Urology and Male Reproductive Health named after R.M. Fronstein of FGAOU VO of I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia
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胡 正, 吕 世, 黄 建, 张 林, 黄 婵, 黎 依, 黄 文, 叶 建, 魏 强. [Three-dimensional spatial measurement versus conventional CT planning in laparoscopic partial nephrectomy for renal tumors]. Nan Fang Yi Ke Da Xue Xue Bao 2018; 38:606-611. [PMID: 29891460 PMCID: PMC6743903 DOI: 10.3969/j.issn.1673-4254.2018.05.17] [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] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To analyze the advantages of spatial measurement of anatomical parameters in a 3D model in surgical planning for laparoscopic partial nephrectomy (LPN). METHODS From February, 2016 to October, 2017, 37 patients diagnosed with T1 renal mass underwent LPN based on 3D reconstruction after enhanced CT scanning using the Uromedix-3D system (group A), and another 38 patients received LPN with conventional CT planning (group B). The anatomical parameters were measured in the reconstructed 3D model and the demographic data, surgical outcome and postoperative data were compared between the two groups. RESULTS In group A, the average time for 3D model reconstruction was (29.3∓9.7) min; the length, width and depth of the renal defect in 3D model were 3.2∓1.1 cm, 2.6∓0.9 cm and 1.7∓0.7 cm, respectively; The distance of the tumor from the collecting system was 3.8∓2.2 mm; The mean R.E.N.A.L score of the patients was 7∓1.5, and 3 patients had accessory renal artery and 2 had early branching of the renal artery. LPNs were completed via the retroperitoneal approach in all the 75 patients without conversion to open or total nephrectomy. Group A and group B showed significant differences in warm ischemic time (26.7∓6.4 vs 31.9∓7.0 min), tumor-excision time (8.4∓2.6 vs 10.4∓2.8 min), renal defect suture time (18.3∓3.9 vs 21.5∓3.4 min), 24-h volume of retroperitoneal drainage (88.6∓40.2 vs 134.3∓58.3 mL) and 48-h volume of retroperitoneal drainage (127.9∓54.5 vs 198.1∓86.3 mL), but not in the demographic data, operation time, intraoperative blood loss or postoperative hospital stay. CONCLUSIONS 3D reconstruction of the renal masses can be completed efficiently and accurately using this system. Compared with conventional CT-based measurement, 3D spatial measurement of the anatomical structures helps to increase the precision in the performance of LPN and reduce the warm ischemia time.
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Affiliation(s)
- 正飞 胡
- 南方医科大学南方医院 泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 世栋 吕
- 南方医科大学南方医院 泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 建锋 黄
- 南方医科大学南方医院 泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 林 张
- 南方医科大学南方医院 泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 婵桃 黄
- 南方医科大学南方医院 影像中心,广东 广州 510515Imaging center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 依文 黎
- 南方医科大学南方医院 影像中心,广东 广州 510515Imaging center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 文华 黄
- 南方医科大学基础医学院人体解剖学教研室,广东 广州 510515Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China
| | - 建平 叶
- 深圳市一图智能科技有限公司,广东 深圳 518044Shenzhen Smart Vision Co., Ltd, Shenzhen 518044, China
| | - 强 魏
- 南方医科大学南方医院 泌尿外科,广东 广州 510515Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Yang C, Wang Z, Huang S, Xue L, Fu D, Chong T. Retroperitoneal Laparoscopic Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1 Renal Hilar Tumor: Comparison of Perioperative Characteristics and Short-Term Functional and Oncologic Outcomes. J Laparoendosc Adv Surg Tech A 2018; 28:1183-1187. [PMID: 29668402 DOI: 10.1089/lap.2018.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To present our single-center experience with retroperitoneal laparoscopic partial nephrectomy (LPN) and retroperitoneal laparoscopic radical nephrectomy (LRN) for T1 renal hilar tumors and evaluate which one is better. METHODS A retrospective review of 63 patients with hilar tumors undergoing retroperitoneal LPN or LRN was performed. The perioperative characteristics, change in estimated glomerular filtration rate (eGFR) from baseline to month 3, and oncologic outcomes were summarized. RESULTS In total, 25 patients underwent LPN, and 38 patients underwent LRN. The mean tumor size in the LPN and LRN groups was 4.5 and 4.9 cm, respectively. The mean operation time was longer in the LPN group than that in the LRN group (212.5 minutes versus 160.7 minutes, respectively; P < .05). Patients undergoing the LPN had a longer median length of hospital stay after surgery (9 days versus 7 days, P < .05). Four percent of patients in the LPN group experienced postoperative complications compared with 5% of patients in the LRN group, which was not significantly different. Compared with preoperative eGFR, postoperative eGFR at 3 months decreased by 15.2 mL/min/1.73 m2 and 27.8 mL/min/1.73 m2 in the LPN and the LRN groups, respectively (P < .05). There was one local recurrence in the LPN group and three local or distant recurrences in the LRN group (P > .05). CONCLUSIONS In experienced hands, although retroperitoneal LRN can result in shorter operation times and shorter lengths of stay, retroperitoneal LPN can preserve renal function better than LRN. Retroperitoneal LPN should be the priority in selected patients with T1 renal hilar tumors, especially for patients with renal insufficiency.
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Affiliation(s)
- Chuance Yang
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
| | - Zhenlong Wang
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
| | - Shanlong Huang
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
| | - Li Xue
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
| | - Delai Fu
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital, Xi'an Jiaotong University , Xi'an, China
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Tanaka K, Teishima J, Takenaka A, Shiroki R, Kobayashi Y, Hattori K, Kanayama HO, Horie S, Yoshino Y, Fujisawa M. Prospective study of robotic partial nephrectomy for renal cancer in Japan: Comparison with a historical control undergoing laparoscopic partial nephrectomy. Int J Urol 2018; 25:472-478. [PMID: 29671904 DOI: 10.1111/iju.13544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/29/2017] [Accepted: 01/31/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the outcomes of robotic partial nephrectomy compared with those of laparoscopic partial nephrectomy for T1 renal tumors in Japanese centers. METHODS Patients with a T1 renal tumor who underwent robotic partial nephrectomy were eligible for inclusion in the present study. The primary end-point consisted of three components: a negative surgical margin, no conversion to open or laparoscopic surgery and a warm ischemia time ≤25 min. We compared data from these patients with the data from a retrospective study of laparoscopic partial nephrectomy carried out in Japan. RESULTS A total of 108 patients were registered in the present study; 105 underwent robotic partial nephrectomy. The proportion of patients who met the primary end-point was 91.3% (95% confidence interval 84.1-95.9%), which was significantly higher than 23.3% in the historical data. Major complications were seen in 19 patients (18.1%). The mean change in the estimated glomerular filtration rate in the operated kidney, 180 days postoperatively, was -10.8 mL/min/1.73 m2 (95% confidence interval -12.3-9.4%). CONCLUSIONS Robotic partial nephrectomy for patients with a T1 renal tumor is a safe, feasible and more effective operative method compared with laparoscopic partial nephrectomy. It can be anticipated that robotic partial nephrectomy will become more widely used in Japan in the future.
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Affiliation(s)
- Kazushi Tanaka
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Jun Teishima
- Department of Urology, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Atsushi Takenaka
- Division of Urology, Tottori University, Yonago, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University, Toyoake, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Tokushima University Graduate School, Tokushima, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Tokyo, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Japanese Society of Endourology Robotic Partial Nephrectomy Study Group, Kobe, Japan
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Jin SJ, Park JY, Kim DH, Yoon SH, Kim E, Hwang JH, Song C, Kim YK. Comparison of postoperative pain between laparoscopic and robot-assisted partial nephrectomies for renal tumors: A propensity score matching analysis. Medicine (Baltimore) 2017; 96:e7581. [PMID: 28723795 PMCID: PMC5521935 DOI: 10.1097/md.0000000000007581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Robot-assisted partial nephrectomy (RAPN) has emerged as an alternative to laparoscopic partial nephrectomy (LPN) for removal of renal tumors. Several advantages of robotic surgery have been reported, but there is no comparative study on postoperative pain between the 2 techniques. Therefore, we compared the postoperative numerical rating scale (NRS) of pain intensity between patients who underwent LPN and those who underwent RAPN.We included 705 patients who underwent either LPN (n = 200) or RAPN (n = 505) for renal tumors between January 2000 and September 2016. After 1:1 propensity score matching, the final analysis included 142 patients each in the LPN and RAPN groups. The primary endpoint was postoperative NRS of pain intensity. The secondary endpoints were opioid requirement, opioid-related complications, and duration of hospital stay.Preoperative and intraoperative values of propensity score matched patients (n = 284) were not significantly different between the LPN and RAPN groups. There was no significant difference in NRS of pain intensity between the 2 groups. Opioid requirement was different between the 2 groups on postoperative day (POD) 0 (12.4 vs 11.3 mg of morphine-equivalent dose), but not from POD 1 to POD 4. The incidence of opioid-related complications and duration of hospital stay were not significantly different between the 2 groups.Postoperative pain was not significantly different between patients who underwent RAPN and those who underwent LPN. This result provides a potentially useful knowledge of postoperative pain characteristics in RAPN and LPN.
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Affiliation(s)
| | | | | | | | - Eunkyul Kim
- Department of Anesthesiology and Pain Medicine
| | | | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Wang Z, Qi L, Yuan P, Zu X, Chen W, Cao Z, Li Y, Wang L. Application of Three-Dimensional Visualization Technology in Laparoscopic Partial Nephrectomy of Renal Tumor: A Comparative Study. J Laparoendosc Adv Surg Tech A 2017; 27:516-523. [PMID: 28186431 DOI: 10.1089/lap.2016.0645] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the effectiveness and safety of individualized three-dimensional visualization technology (3DVT) on surgical planning and perioperative outcomes in laparoscopic partial nephrectomy (LPN) for renal cell carcinoma (RCC) with routine computed tomography (CT) examination in the treatment of renal tumor. METHODS From May 2015 to March 2016, a total of 94 patients with cT1 RCC who underwent surgical treatment in our department were analyzed retrospectively. Among these patients, a total of 49 cases received LPN with operation plan based on 3DVT. Surgical plan was obtained by virtual operation and morphometry on 3D reconstruction model. The remaining 45 cases received surgical treatment with traditional CT examination. Patient demographic, surgical outcome, and postoperative parameters were compared between these two groups. RESULTS No significant difference was found in blood loss volume, postoperative complication, selective clamping success rate, changes in postoperative renal function, and operative and ischemic time between the two groups. However, when handling complicated tumor with R.E.N.A.L score ≥8, operation time (126.7 ± 36.4 versus 154.8 ± 34.7, P = .018) and occurrence of postoperative urinary leak (0 versus 4, 0% versus 22.2%, P = .033) were diminished significantly in the 3DVT group. CONCLUSIONS 3DVT provided precise information of anatomical structure in the operative area and reliable guidance for preoperative plan design. Our results indicated that 3DVT facilitated accurate visible image-guided tumor resection with ideal renal function preservation in LPN for renal tumor of high complexity.
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Affiliation(s)
- Zhi Wang
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Lin Qi
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Peng Yuan
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Xiongbing Zu
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Wei Chen
- 2 Department of Radiology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Zhenzhen Cao
- 3 Department of Gynecologic Oncology, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya Medical School, Central South University , Changsha, P.R. China
| | - Yuan Li
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
| | - Long Wang
- 1 Department of Urology, Xiangya Hospital, Central South University , Changsha, P.R. China
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Shpot EV, Pshikhachev AM. [Principles of surgical treatment of patients with renal tumor and coexistent contralateral kidney stone]. Urologiia 2016:76-83. [PMID: 28248048] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To determine the treatment strategy for patients with renal tumors and coexistent contralateral kidney stone. MATERIALS AND METHODS From 2006 to 2015, 1380 and 4833 patients underwent surgery for renal tumours and kidney stones, respectively. The combination of stone disease and renal tumor was found in 159 (11.5%) patients, of whom 61 patients had indications for surgical treatment of both diseases at the time of hospital admission. Of these, 17 (27.9%) patients (8 men and 9 women) had renal tumors and coexistent contralateral kidney stone. RESULTS Initial surgery for stones was performed in 10 (58.8%) cases. In the remaining 7 (41.2%) patients, the first operation was for renal tumors. None of the patients underwent simultaneous removal of the contralateral kidney stone. The most common types of treatment for kidney stones were percutaneous nephrolithotripsy and extracorporeal shock-wave lithotripsy. Twelve (70.6%) patients underwent partial nephrectomy, the remaining 5 (29.4%) had nephrectomy. In total, 17 patients with renal tumors and coexistent contralateral kidney stones were treated using 11 different treatment combinations. These results show the need to define treatment strategies for each patient individually, taking into account all possible factors. CONCLUSIONS In patients with renal tumors and coexistent contralateral kidney stone, the basic principle of surgical treatment is to perform an organ-sparing surgery, given technical feasibility and normal function of kidney, affected by the tumor.
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Affiliation(s)
- E V Shpot
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
| | - A M Pshikhachev
- Department of Urology, I.M. Sechenov First MSMU, Research Institute of Uronephrology and Human Reproductive Health
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Abstract
PURPOSE Saving warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) is important. We have designed a new device, a remotely activated bulldog clamp, to facilitate LPN. In present study, the effectiveness, convenience, and safety of the new design device were compared with that of standard bulldog vascular clamp in a pig model. MATERIALS AND METHODS Fifteen cases of LPN were bilaterally operated on upper or lower pole of kidneys in five pigs. As the test group, eight cases involved the remotely activated bulldog clamp, whereas the remaining seven cases, as the control group, involved the common standard vascular bulldog clamp. The mean operative time, blood lost, and mean WIT were compared between the two groups. RESULTS The mean operative time and blood lost were not significantly different between the groups (p < 0.05). Continuous artery clamping was used in the two groups. With on-demand clamping, the mean WIT in the test group was 19.0 ± 3.42 minutes, which was significantly less compared with the control group (31.54 ± 5.23 minutes, p < 0.05). CONCLUSIONS The newly designed device can remotely control the renal artery, which made clamping and unclamping much easier. It is effective and safe in LPN.
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Affiliation(s)
- Wei Chen
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jian-Ming Guo
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jun Hou
- 2 Pathology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Guo-Min Wang
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
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Vitagliano G, Lopez F, Guglielmi JM, Mieggi M, Blas L, Rico L, Ameri C. Synthetic Renal Capsule Tailoring: A Novel Renorrhaphy Technique After Subcapsular Dissection of Renal Tumors with Severe Adherent Perirenal Fat During Laparoscopic Partial Nephrectomy. J Laparoendosc Adv Surg Tech A 2016; 27:717-721. [PMID: 27455068 DOI: 10.1089/lap.2016.0318] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multiple factors can account for surgical complexity during laparoscopic partial nephrectomy (LPN); severe adhesion of perirenal fat (PRF) is a crucial one. Consequent renal decapsulation can deem renorrhaphy a very challenging task. We propose a novel technique (synthetic renal capsule tailoring [SYRCT]) to facilitate renorrhaphy in decapsulated kidneys and suggest early decapsulation as a safe option in cases with severe PRF. MATERIALS AND METHODS We retrospectively analyzed perioperative results of this novel technique performed in cases with severe PRF. All cases were classified as high grade in the Mayo Adhesive Probability (MAP) score. RESULTS A total of six cases were performed with the SYRCT technique. All patients were male with a mean age of 70 years (62-76 years) and mean body mass index of 30 kg/m2 (23.66-33.86). Of the six cases, five were T1a and 1 T1b. Mean tumor size was 2.83 cm (range 1.2-6 cm). Mean operative time was 121 minutes (range 74-150 minutes); mean warm ischemia time was 17.2 minutes (range 13-25 minutes). Mean operative bleeding was 128 mL (range 50-250 mL). Mean hospital stay was 2.3 days. There were no surgical complications greater or equal to Clavien II. CONCLUSION Performing complete renal decapsulation with subcapsular dissection and SYRCT in cases with high MAP score and severe PRF is safe and reproducible. Using this novel technique, we were able to obtain perioperative results comparable to the ones we found in LPN with normal PRF.
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Affiliation(s)
- Gonzalo Vitagliano
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Francisco Lopez
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Juan Manuel Guglielmi
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Mauro Mieggi
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Leandro Blas
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Luis Rico
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
| | - Carlos Ameri
- Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina
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Sugiura M, Suyama T, Kanesaka M, Fujimoto A, Hou K, Araki K, Masuda H, Kojima S, Naya Y. Usefulness of R.E.N.A.L Nephrometry Scoring System and Centrality Index Score for Predicting Outcome of Laparoscopic Partial Nephrectomy. J Laparoendosc Adv Surg Tech A 2016; 26:784-788. [PMID: 27732324 DOI: 10.1089/lap.2016.0025] [Citation(s) in RCA: 8] [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] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the clinical usefulness for prediction of outcome of laparoscopic partial nephrectomy (LPN) using the R.E.N.A.L nephrometry scoring system (RNS) and centrality index score (C-index). MATERIALS AND METHODS We retrospectively reviewed 64 patients who underwent LPN from 2010 to 2014 in our institution. The RNS and C-index scores were assigned according to the described protocols for their systems. The relationships between the patients' scores before surgery and the outcomes of LPN, warm ischemia time (WIT), operative time (ORT), estimated blood loss (EBL), and percent change in estimated glomerular filtration rate (eGFR) were analyzed retrospectively. RESULTS Mean tumor size was 3.1 cm, mean WIT was 27.6 minutes, mean ORT was 189.0 minutes, and mean EBL was 187 mL. Although the RNS had statistically significant correlations with WIT, ORT, and percent change in eGFR, these correlations were not score-dependent. For WIT, a statistically significant difference was observed between the low-risk group and the middle-risk group. For percent change in eGFR, a statistically significant difference was observed between the low-risk group and the high-risk group only. For the C-index, statistically significant correlations between complexity categories and WIT, ORT, EBL, and percent change in eGFR were observed. Regarding the raw C-index scores, linear correlations were observed between the scores and each outcome of LPN. CONCLUSIONS The RNS and C-index are useful for predicting the complexity of LPN. The C-index may be more suitable than the RNS for predicting postoperative renal function.
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Affiliation(s)
- Masahiro Sugiura
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Takahito Suyama
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Manato Kanesaka
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Ayumi Fujimoto
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Kyokushin Hou
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Kazuhiro Araki
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Hiroshi Masuda
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Satoko Kojima
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Yukio Naya
- Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
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Kanno T, Kubota M, Sakamoto H, Nishiyama R, Oida T, Okada T, Akao T, Higashi Y, Kawamura J, Yamada H. THE FACTORS THAT AFFECT THE DECISION TO PERFORM LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR SMALL RENAL TUMOR. Nihon Hinyokika Gakkai Zasshi 2016; 107:73-8. [PMID: 28442673 DOI: 10.5980/jpnjurol.107.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objectives) Nephron sparing surgery (NSS) is strongly recommended for patients with T1a renal cell carcinoma (RCC) whenever surgically feasible. However, partial nephrectomy, particularly laparoscopic approach, remains underutilized in Japan compared to laparoscopic radical nephrectomy (LRN). In this study, we examined the safety and efficacy of laparoscopic partial nephrectomy (LPN) for T1a RCC compared to LRN. We also assessed the factors that affect the decision to perform LPN or LRN. (Patients and methods) From March 2001 to September 2014, 112 patients with T1a renal tumors received renal surgery at our institution. Of these, 100 patients (LPN: 36 patients, LRN: 64 patients) underwent laparoscopic surgery. Treatment outcomes including surgical and oncological outcomes among each approach were compared. In addition, multivariate analysis was performed to reveal the factors that affect the decision on surgical approach. (Results) The ratio of patients more than 75 years old and the RENAL nephrometry score were higher in LRN group than those in LPN group. Operating time was longer but renal function was well preserved in LPN group. Importantly, blood loss, intraoperative and postoperative complication rate, and oncological outcome (recurrence-free survival and overall survival) were similar in both groups. Multivariate analysis revealed that age (≥75 years old), high RENAL nephrometry score, operation period (before 2011), and the absence of Endoscopic Surgical Skill Qualification (ESSQ) in surgeon were independent predictive factors that select LRN. (Conclusions) Our data suggests that LPN for T1a renal tumor could be performed safely and the decision whether LPN or LRN were performed were associated with technical factors such as the presence of ESSQ or operation period, as well as patient's factor such as age and tumor factor such as tumor complexity.
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