Routine delayed shunting associated with standardisation of the technique seems to be a safe and effective technique and contributes to maintaining the RNCR < 1% over time and independently from operators and other clinical factors.
Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.
The authors would like to clarify some aspects regarding the technique of routine delayed shunting used in carotid endarterectomy.In the single centre experience reported (Padova University, Vascular and Endovascular Surgery Clinic), 1 all 1745 patients underwent carotid endarterectomy over a 10 year period (2007e2016), and were performed using the same technique of routine delayed shunting as described in the methods section.In the Discussion it was unintentionally stated that "no studies had focused their attention on the technique used for shunt insertion". This sentence was used to point out that while plentiful data regarding the strategy for shunting (routine or selective) are present in the literature, no other Vascular Research Institution focused on the technique and timing of shunt insertion (before or after endarterectomy). However, it is to be acknowledged that at the study institution this technique of routine shunt insertion just after endarterectomy had been defined already and standardised by Deriu et al. 2 in 1999 when they studied the threshold for clamp ischaemia time and the delayed shunt insertion for endarterectomy with patch. After these studies in 2002 Deriu et al. 3 standardised this technique looking for the gold standard in carotid endarterectomy.The authors would like to apologise for any inconvenience caused.
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