Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial

Anderson, Barrett G.; Potretzke, Aaron M.; Du, Kefu; Vetter, Joel; Bergeron, Karla; Paradis, Alethea; Figenshau, R. Sherburne

doi:10.1016/j.urology.2018.11.053

Cited by 67 publications

(68 citation statements)

References 29 publications

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“…However, dissecting tumor feeding arteries from the renal hilum is technically difficult and time-consuming. Off-clamp LPN has been developing and popularizing among the urologic communities [16,17], and it's very important to clarify and understand the tumor and renal vascular anatomy before surgery, especially intrarenal relationships of the tumor and feeding arteries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

Jiang

et al. 2020

BMC Med Imaging

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Background: With the development of three dimensional (3D) reconstruction and printing technology, it has been widely using in the field of urology. However, there have been few studies reporting the role of 3D reconstruction in zero-ischemia partial nephrectomy (PN). The aim of this study was to assess the role of 3D reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 who underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) preoperatively were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiological findings were directly correlated with intraoperative surgical findings at laparoscopy. Baseline, perioperative variables and the rate of accurate tumor feeding artery orientation were compared between groups. Results: All LPNs were completed without conversion to renal hilar clamping or open surgery. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P > 0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P < 0.05) and the rate of accurate tumor feeding artery dissection was higher in the 3D group (91.7%) in comparison with the CTA group (84.2%). The baseline characteristics and renal function outcomes had no statistical differences between groups.

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Section: Discussionmentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

Jiang

et al. 2020

BMC Med Imaging

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“…We included 13 observational studies, in which there was a description of functional and oncologic results in patients undergoing PN without ischemia compared with PN with warm ischemia [ 15 17 18 19 20 21 22 23 24 25 26 27 28 ], and one clinical trial [ 29 ] ( Table 1 ) [ 15 17 18 19 20 21 22 23 24 25 26 27 28 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eight of the included studies allowed evaluation of the primary outcome because data was provided on the change in estimated GFR (eGFR); in a smaller proportion of studies, the proposed secondary outcomes could be evaluated ( Table 2 ) [ 15 17 18 19 20 21 22 23 24 25 26 27 28 29 ].…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness and safety of partial nephrectomy—no ischemia vs. warm ischemia: Systematic review and meta-analysis

2020

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This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the deterioration in renal function in patients with cT1 renal tumors. Materials and Methods: We conducted a systematic review that included patients over 18 years of age who underwent PN with or without warm ischemia for cT1 renal tumors. The primary outcome was impaired renal function. A search strategy was performed in MEDLINE, EMBASE, LILACS, CENTRAL, the article reference lists, and the unpublished literature to reach saturation of the information. We assessed the risk of bias with the methodological index for nonrandomized studies (MINORS) tool, and we performed a meta-analysis according to the type of variable. Results: We found a total of 5,682 articles, of which 14 met the inclusion criteria. Seven studies evaluated renal function, identifying a difference in means (MD) of 3.50 (95% confidence interval [CI], 1.16 to 5.83), favoring no ischemia. We did not find any significant differences regarding intraoperative bleeding or operative time (MD, 55 mL; 95% CI,-33.16 to 144.08; and MD, 1.87; 95% CI,-20.47 to 24.21; respectively). Conclusions: In this study, PN without ischemia showed a decrease in deterioration of the estimated glomerular filtration rate compared with warm ischemia.

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“…However, dissecting tumor feeding arteries from the renal hilum is technically difficult and timeconsuming. Although off-clamp LPN has been developing and popularizing among the urologic communities [15,16], the uncertainty of the intrarenal relationships of the tumor and feeding arteries makes off-clamp partial nephrectomy even more difficult. Therefore, preoperative understanding of the tumor and renal vascular anatomy is of great importance.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

Jiang

et al. 2019

Preprint

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Background: Advances in the three dimensional (3D) reconstruction and printing technology have fueled a rapidly growing interest in its applications in the field of urology. To our knowledge, the experience on the use of 3D reconstruction to facilitate zero-ischemia partial nephrectomy (PN) remains sparse and the role of 3D reconstruction is still needed to be defined. This study aimed to assess the role of three-dimensional (3D) reconstruction and conventional computer tomography angiography (CTA) in zero-ischemia laparoscopic partial nephrectomy (LPN). Methods: A total of 60 consecutive patients undergoing zero-ischemia LPN between October 2017 and March 2018 underwent CTA (CTA group including 30 patients) and 3D reconstruction (3D group including the remaining 30 patients) were included. 3D reconstruction and CTA images were prepared which were used to demonstrate the number and spatial interrelationships of the location of renal tumors and tumor feeding arteries. These radiology findings were directly correlated with intraoperative surgical findings at laparoscopy. Demographics, perioperative characteristics and renal function were compared between groups. Results: CTA and 3D reconstruction were successfully performed without any related complications. All the procedures were performed successfully without conversion to main renal artery clamping. Preoperative 3D reconstruction identified that 15 patients had only one tumor feeding artery, 12 had two, and another 3 had three, while the conventional CTA revealed that 22 patients had one tumor feeding artery, 8 had two (P>0.05). The mean operation time was shorter and estimated blood loss was less in the 3D group (P<0.05). 3D reconstruction group resulted in more accurate dissection of tumor artery (91.7%) as compared to conventional CTA (84.2%). There were no statistical differences in the baseline characteristics and renal function outcomes between two groups. Conclusions: 3D reconstruction can provide comprehensive information for the preoperative evaluation and intraoperative orientation that may facilitate tumor resection during zero-ischemia LPN for renal tumors.

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Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial

Cited by 67 publications

References 29 publications

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

Effectiveness and safety of partial nephrectomy—no ischemia vs. warm ischemia: Systematic review and meta-analysis

Comparison of three dimensional reconstruction and conventional computer tomography angiography in patients undergoing zero-ischemia laparoscopic partial nephrectomy

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