Feasibility of Omitting Cortical Renorrhaphy During Robot-Assisted Partial Nephrectomy: A Matched Analysis

Bahler, Clinton D.; Dube, Hitesh; Flynn, Kevin J.; Garg, Swapnil; Monn, M. Francesca; Gutwein, Luke G.; Mellon, Matthew J.; Foster, Richard S.; Cheng, Liang; Sandrasegaran, M. Kumar; Sundaram, Chandru P.

doi:10.1089/end.2014.0763

Cited by 67 publications

(55 citation statements)

References 18 publications

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“…The sutures further damage the renal parenchyma causing devascularized volume loss. In line with our findings, Bahler et al [29] who evaluated functional volume loss after tumor enucleation reported an advantage of the non-renorrhaphy technique over standard sutures. Patients who were managed with running sutures of the base of tumor bed only had almost twofold increases in the preserved viable renal tissue [29].…”

Section: Discussionsupporting

confidence: 92%

“…In line with our findings, Bahler et al [29] who evaluated functional volume loss after tumor enucleation reported an advantage of the non-renorrhaphy technique over standard sutures. Patients who were managed with running sutures of the base of tumor bed only had almost twofold increases in the preserved viable renal tissue [29]. They concluded that careful reconstruction of the tumor bed can reduce the amount of devascularized parenchyma, and is considered one of the most important modifiable factors for renal function preservation after NSS.…”

Section: Discussionsupporting

confidence: 92%

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Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

et al. 2018

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Introduction: The aim of our study was to examine the influence of tumor complexity and operative variables on the degree and rate of post-nephron sparing surgery (NSS) acute kidney injury (AKI). Methods: We retrospectively reviewed the records of 477 patients who underwent NSS for enhancing renal masses in our institution. AKI was determined using the latest definition by AKIN and RIFLE criteria. Serum creatinine was assessed daily starting from day 1 post-surgery and until discharge (usually on postoperative day 3). Estimated glomerular filtration was determined using the Modification of Diet in Renal Disease equation. Results: Overall, 191 patients (40%) developed postoperative AKI, and most of them (88%) were grade 1. Multivariate analysis revealed that the most significant and independent variables associated with AKI were operation time (p = 0.02), ischemia time (p = 0.02), and the use of tissue adhesive for tumor bed closure (p = 0.02). Other important factors (by univariate analysis) were the need for blood transfusion (p = 0.003) and estimated blood loss (p = 0.007). Conclusions: Operative time, ischemia, and tumor bed closure method are independent predictors of post-NSS AKI. Efforts should be made to limit prolonged ischemia and to reduce viable parenchymal loss. Further studies concerning the functional impact of AKI in these patients will be required.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

et al. 2018

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“…40 Some studies showed that omission of cortical renorrhaphy appears feasible with no urine leaks or bleeding complications observed. 41 They also reported that the percentage of renal volume loss was improved by omission of cortical renorrhaphy. Reconstruction techniques are important to control for postoperative hemorrhage and studying renal function after NSS.…”

Section: Sliding-clip Renorrhaphy and Barbed Suturementioning

confidence: 98%

“…Some studies showed that omission of cortical renorrhaphy appears feasible with no urine leaks or bleeding complications observed . They also reported that the percentage of renal volume loss was improved by omission of cortical renorrhaphy.…”

Section: Technical Advancementsmentioning

confidence: 99%

Robot‐assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy

et al. 2015

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Nephron-sparing surgery has been proven to positively impact the postoperative quality of life for the treatment of small renal tumors, possibly leading to functional improvements. Laparoscopic partial nephrectomy is still one of the most demanding procedures in urological surgery. Laparoscopic partial nephrectomy sometimes results in extended warm ischemic time and severe complications, such as open conversion, postoperative hemorrhage and urine leakage. Robot-assisted partial nephrectomy exploits the advantages offered by the da Vinci Surgical System to laparoscopic partial nephrectomy, equipped with 3-D vision and a better degree in the freedom of surgical instruments. The introduction of the da Vinci Surgical System made nephron-sparing surgery, specifically robot-assisted partial nephrectomy, safe with promising results, leading to the shortening of warm ischemic time and a reduction in perioperative complications. Even for complex and challenging tumors, robotic assistance is expected to provide the benefit of minimally-invasive surgery with safe and satisfactory renal function. Warm ischemic time is the modifiable factor during robotassisted partial nephrectomy to affect postoperative kidney function. We analyzed the predictive factors for extended warm ischemic time from our robot-assisted partial nephrectomy series. The surface area of the tumor attached to the kidney parenchyma was shown to significantly affect the extended warm ischemic time during robot-assisted partial nephrectomy. In cases with tumor-attached surface area more than 15 cm 2 , we should consider switching robot-assisted partial nephrectomy to open partial nephrectomy under cold ischemia if it is imperative. In Japan, a nationwide prospective study has been carried out to show the superiority of robot-assisted partial nephrectomy to laparoscopic partial nephrectomy in improving warm ischemic time and complications. By facilitating robotic technology, robot-assisted partial nephrectomy will be more frequently carried out as a safe, effective and minimally-invasive nephronsparing surgery procedure.

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“…Efforts continue to understand post-PN renal function and to improve it with the aim to maximize the additional benefits the robot-assisted approach could bring. [9][10][11] In the present study, we aimed to identify whether differences in surgical details had an impact on post-RAPN renal function.…”

Section: Introductionmentioning

confidence: 99%

Surgical details and renal function change after robot‐assisted partial nephrectomy

et al. 2020

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Abbreviations & Acronyms BMI = body mass index CI = confidence interval CKD = chronic kidney disease CT = computed tomography DM = diabetes mellitus DTPA = diethylenetetramine pentaacetic acid GFR = glomerular filtration rate IQR = interquartile range PN = partial nephrectomy RAPN = robot-assisted partial nephrectomy WIT = warm ischemic time Objectives: To investigate whether differences in surgical details during robot-assisted partial nephrectomy impact postoperative renal function. Methods: Patient, tumor and perioperative characteristics of 751 patients who underwent robot-assisted partial nephrectomy were analyzed with respect to the difference in ipsilateral glomerular filtration rate measured by diethylenetetramine pentaacetic acid renal scan. Detailed surgical methods defined for tumor excision (cutting vs splitting), hemostasis (suturing vs clipping) and renorrhaphy (continuous vs interrupted) were analyzed for early glomerular filtration rate decline and long-term recovery.Results: The glomerular filtration rate of the entire cohort decreased by 9.8 mL/min/ 1.73 m 2 (22%) at 3 months postoperatively, gradually increasing thereafter. The recovery slope was 1.7 mL/min/1.73 m 2 /year during a median follow-up period of 23.0 months. Early glomerular filtration rate decline was more pronounced in the cutting group (23.5 vs 20.1%, P = 0.009). Clipping was associated with less glomerular filtration rate decline throughout the observation period, and the recovery slope was also significantly higher (2.7 vs 1.1 mL/min/1.73 m 2 /year). In multivariate analysis, early decline was associated with age, preoperative glomerular filtration rate, parenchymal volume loss and ischemia >25 min. With respect to long-term recovery, suturing had the greatest adverse impact (b = À5.060, P < 0.0001, 95% confidence interval À7.709, À2.411) in addition to parenchymal volume reduction and early decline. In the propensity-matched cohort accounting for differences in tumor size and complexity, suturing was persistently associated with a significant glomerular filtration rate decline until >2 years after surgery. Conclusions: Hemostatic sutures during robot-assisted partial nephrectomy might interfere with long-term renal function recovery irrespective of parameters that determine the initial function change. As the splitting method reduces the use of sutures, modifying these details might help preserve renal function.

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Feasibility of Omitting Cortical Renorrhaphy During Robot-Assisted Partial Nephrectomy: A Matched Analysis

Cited by 67 publications

References 18 publications

Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

Method Used for Tumor Bed Closure (Suture vs. Sealant), Ischemia Time and Duration of Surgery are Independent Predictors of Post-Nephron Sparing Surgery Acute Kidney Injury

Robot‐assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy

Surgical details and renal function change after robot‐assisted partial nephrectomy

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