252 Robotic Partial Nephrectomies: Evolving Renorrhaphy Technique and Surgical Outcomes at a Single Institution

Kaouk, Jihad; Hillyer, Shahab; Autorino, Riccardo; Haber, Georges-Pascal; Gao, Tianming; Altunrende, Fatih; Khanna, Rakesh; Spana, Gregory; White, Michael A.; Laydner, Humberto; Isac, Wahib; Stein, Robert J.

doi:10.1016/j.urology.2011.08.007

Cited by 85 publications

(44 citation statements)

References 24 publications

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“…The largest single institution series published by the Cleveland clinic has described their evolving techniques. 7,28 Their initial experience included interrupted bolstered renorraphy compared with a continuous horizontal mattress stitch in their contemporary experience. Their type of clamping also varied over time, including laparoscopic bulldogs clamps versus a Satinsky clamp, both artery and vein clamping versus only arterial clamping, and unclamping before versus after renal capsula suturing.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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“…The option of non-occlusion of the hilum was dependent on tumor size, tumor location and the surgeon's decision from intraoperative findings. A non-bolstered continuous horizontal mattress stitch with intermittent placement of sliding Hem-O-Lok clips (Weck Closure System, Research Triangle Park, NC, USA) was used for the renal capsular closure 12 ( Fig. 2).…”

Section: Surgical Techniquementioning

confidence: 99%

Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney: A single institution comparative analysis

et al. 2012

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Objectives: To compare the outcomes of robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy for renal tumor in patients with a solitary kidney. Methods: We retrospectively reviewed data of patients with solitary kidney who underwent laparoscopic (n = 52) and robot-assisted (n = 15) partial nephrectomy for renal tumor at Cleveland Clinic, Cleveland, Ohio, USA, between June 2000 and April 2012. Patient demographic data, perioperative parameters and follow-up data were compared. Results: The two groups were similar in terms of patients and tumor characteristics, including preoperative renal function and etiology of solitary kidney. The median operative time (225 vs 171 min, P = 0.02), warm ischemia time (19 vs 15 min, P = 0.04) and hospital stay (4 vs 3 days, P = 0.03) were significantly shorter in the robotic group. No significant differences were found in terms of estimated blood loss, transfusion, complications, pathological results and margin status. The median percentage change of renal function was not significantly different between two groups. Long-term hemodialysis was required for three patients in the laparoscopic group (6%) and none of the patients in the robotic group. Median follow up was 15.6 and 5.9 months in the laparoscopic and robotic group, respectively. Conclusions: Robot-assisted partial nephrectomy represents a safe and effective minimally-invasive treatment option for renal masses in patients with a solitary kidney. Early comparative outcomes suggest that it offers a significant benefit over the laparoscopic approach in terms of operative time, warm ischemia time and hospital stay. Further studies with a longer follow up are required to confirm the likelihood of better long-term functional and oncological outcomes.

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“…This practice has been carried from early open PN to LPN and even early RPN experience (9,18,19). Ureteral catheterization is time consuming, incurs additional cost and is not without risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Early in our robotic experience, standard interrupted bolstered renorrhaphy was used for capsule closure (18).…”

Section: Surgical Techniquementioning

confidence: 99%

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods: MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak.Results: A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon's early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion: Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.

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252 Robotic Partial Nephrectomies: Evolving Renorrhaphy Technique and Surgical Outcomes at a Single Institution

Cited by 85 publications

References 24 publications

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney: A single institution comparative analysis

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

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