Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes

Dell’Atti, Lucio; Scarcella, Simone; Manno, Stefano; Polito, Massimo; Galosi, Andrea Benedetto

doi:10.1016/j.clgc.2018.07.020

Cited by 19 publications

(12 citation statements)

References 21 publications

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“…The most important factor in preserving renal function during PN is the percent of nephron mass preserved [6,. In our series, one of our main findings relates to nephron mass preservation, which is of primary importance for functional recovery, consistent with reports from other studies that eGFR of small renal cancer was not significantly different pre-and postoperatively [10][11].…”

Section: Discussionsupporting

confidence: 91%

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Single-Port Sutureless Partial Nephrectomy for Small Renal Cancer

Chien

Yeh

et al. 2020

Preprint

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Background: Laparoscopic single-port (LESS) sutureless partial nephrectomy (PN) is a technically demanding procedure. Here we shared our experience to reduce the warm ischemia time and shorten the learning curve in performing LESS sutureless PN. Materials and methods:Between 2015 and 2018, custom made LESS sutureless PN was performed in 33 patients with small renal cancer. Preoperative, intra-operative and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre-and postoperatively. Results:The average warm ischemia time and the operation time were 11.8 ± 3.9 min and 167.9 ± 37.5 min, respectively. Only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after the surgery. eGFR and serum hemoglobin were not found to be significantly different pre-and postoperatively. All tumors were removed without positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-up of 16.5 ± 6.4 months.Conclusions: LESS sutureless PN is a feasible surgical method for most patients with small renal cancer with excellent cosmetic results, shorter learning curve without affecting oncological results. randomized controlled studies have compared the safety and oncological outcomes in terms of renal function and surgical margins, the steep learning curve with laparoscopic partial nephrectomy (LPN) remains a concern [4]. LPN is a technically demanding procedure, even under robotic assistance.Several important challenges, such as preventing perioperative bleeding, reaching hyperthermia after renal artery clamping, reducing warm ischemia time, and performing laparoscopic intracorporeal suturing, must be met during the operation. Despite the ability to achieve renal hyperthermia by delivering cold saline into the renal pelvis, the cooling effect is not qualified during laparoscopic surgery. Gill et al.[5] reported a novel method using ice slush around the kidney; however, it is difficult to replicate during the laparoscopic procedure. Because it is difficult to achieve renal hypothermia during LPN, it is important to reduce the warm ischemia time, which is understood to correlate with subsequent return of renal function [6]. Traditional clamping procedures require a significant warm ischemia time during the suturing process. Hemostatic suturing plays a vitally important role, even in the current era of early unclamping [7], selective clamping [8], and unclamping techniques [9-11].We previously shared our "pressure-cooker" method of performing LPN without intracorporeal suturing [12]. In the current study, we present our technique of laparoendoscopic single-site (LESS) sutureless PN. Our method is shown to reduce the warm ischemia time, and we believe this technique will shorten the learning curve in performing LPN for surgeons who lack experience in intracorporeal suturing.

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Section: Discussionsupporting

confidence: 91%

“…Traditional clamping procedures require a significant warm ischemia time during the suturing process. Hemostatic suturing plays a vitally important role, even in the current era of early unclamping [7], selective clamping [8], and unclamping techniques [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Single-Port Sutureless Partial Nephrectomy for Small Renal Cancer

Chien

Yeh

et al. 2020

Preprint

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“…To optimize the renal function preservation, tumor enucleation (TE) technique has been developed by excising the tumor without normal parenchyma along a natural cleavage between the peritumoral pseudocapsule (PC) and healthy parenchyma (3)(4)(5). Recently, Dell'Atti et al developed an unclamped sutureless laparoscopic simple enucleation technique for renal tumors with low nephrometry score (6). After analyzing the complication rates, functional and oncological outcomes, we found that this innovative technique was a rational and safe approach.…”

Section: Introductionmentioning

confidence: 99%

A preoperative nomogram predicting the pseudocapsule status in localized renal cell carcinoma

Hu¹,

Chen²,

Li³

et al. 2020

Transl Androl Urol

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Background: Tumor enucleation (TE) surgery for localized renal cell carcinoma (RCC) relies on a complete peritumoral pseudocapsule (PC). Study objective was to develop a preoperative model to predict PC status.Methods: The prediction model was developed in a cohort that consisted of 170 patients with localized RCC, and data was gathered from 2010 to 2015. Multivariable logistic regression analysis and R were used to generate this prediction model. The statistical performance was assessed with respect to the calibration, discrimination, and clinical usefulness.Results: The prediction model incorporated the systemic inflammatory markers [neutrophil-lymphocyte ratio (NLR); albumin-globulin ratio (AGR)], CT imaging features (tumor size and necrosis), and clinical risk factors (BMI). The model showed good discrimination, with a C-index of 0.85 (0.78-0.91), and good calibration (P=0.60). The sensitivity and specificity were 62% and 94% respectively. Decision curves and clinical impact curve demonstrated that the current model was clinically useful. Conclusions:We constructed a model that incorporated both the systematic inflammatory markers and clinical risk factors. It can be conveniently used to preoperatively predict the individualized risk of PC invasion and identify the best candidates to receive TE surgery.

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“…In recent years, some urologists have been focused on sutureless PN and tried to prove its safety and feasibility (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Without suture, the difficulty of operation is reduced, and the operation time is saved.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Sutureless Versus Suture Partial Nephrectomy for Clinical T1 Renal Cell Carcinoma: A Meta-Analysis of Retrospective Studies

Zhang

Che

et al. 2021

Front. Oncol.

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BackgroundPartial nephrectomy (PN) is the recommended treatment for T1 renal cell carcinoma (RCC). Compared with suture PN, sutureless PN reduces the difficulty and time of operation, but the safety and feasibility have been controversial. This meta-analysis was conducted to compare the function and perioperative outcomes of suture and sutureless PN for T1 RCC.MethodsSystematic literature review was performed up to April 2021 using multiple databases to identify eligible comparative studies. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, identification and selection of the studies were conducted. Meta-analysis was performed for studies comparing suture to sutureless PN for both T1a and T1b RCC. In addition, subgroup analysis was performed on operation time, warm ischemia time, estimated blood loss, and postoperative complications. Sensitivity analysis was used in analysis with high heterogeneity (operation time and estimated blood loss).ResultsEight retrospective studies were included with a total of 1,156 patients; of the 1,156 patients, 499 received sutureless PN and 707 received suture PN. The results showed that sutureless PN had shorter operative time (I2 = 0%, P < 0.001), warm ischemia time (I2 = 97.5%, P < 0.001), and lower clamping rate (I2 = 85.8%, P = 0.003), but estimated blood loss (I2 = 76.6%, P = 0.064) had no difference. In the comparison of perioperative outcomes, there was no significant difference in postoperative complications (I2 = 0%, P = 0.999), positive surgical margins (I2 = 0%, P = 0.356), postoperative estimated glomerular filtration rat (eGFR) (I2 = 0%, P = 0.656), and tumor recurrence (I2 = 0%, P = 0.531).ConclusionsIn T1a RCC with low RENAL score, sutureless PN is a feasible choice, whereas it should not be overestimated in T1b RCC.

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Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes

Cited by 19 publications

References 21 publications

Single-Port Sutureless Partial Nephrectomy for Small Renal Cancer

Single-Port Sutureless Partial Nephrectomy for Small Renal Cancer

A preoperative nomogram predicting the pseudocapsule status in localized renal cell carcinoma

Comparison of Sutureless Versus Suture Partial Nephrectomy for Clinical T1 Renal Cell Carcinoma: A Meta-Analysis of Retrospective Studies

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