Hand-assisted laparoscopic partial nephrectomy after 60 cases: comparison with open partial nephrectomy

DeVoe, William B.; Kercher, Kent W.; Hope, William W.; Lincourt, Amy E.; Norton, H. James; Teigland, Chris M.

doi:10.1007/s00464-008-0135-2

Cited by 19 publications

(9 citation statements)

References 22 publications

(34 reference statements)

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“…Small renal masses are increasingly being discovered incidentally on imaging for other reasons [1–3]. When surgically excised, about 80% of these masses are revealed to be renal cell carcinoma [4–7]. Traditionally, surgical excision by radical nephrectomy has been the standard treatment for all solid enhancing renal masses.…”

Section: Introductionmentioning

confidence: 99%

Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta‐analysis of case series studies

2012

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What ' s known on the subject? and What does the study add?The oncological success of partial nephrectomy in the treatment of small renal masses is well established. However, partial nephrectomy has largely supplanted the radical approach. In the last decade, laparoscopy has been adopted as the new surgical approach for the treatment of renal cell carcinoma. Laparoscopy offers the advantage of lower analgesic use, shorter hospital stay, and quicker recovery time. More recently, ablative technologies have been investigated as an alternative to laparoscopic partial nephrectomy. These techniques can often be performed percutaneously in the radiology suite, or laparoscopically without the need for hilar clamping. However, only the cryoablation and radiofrequency ablation modalities have had widespread use with several series reporting short to intermediate results.This review shows that both cryoablation and radiofrequency ablation are promising therapies in patients with small renal tumours ( < 4 cm), who are considered poor candidates for more involved surgery. OBJECTIVE• To determine the current status of the literature regarding the clinical effi cacy and complication rates of cryoablation vs radiofrequency ablation in the treatment of small renal tumours. METHODS• A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: MEDLINE, EMBASE and LILACS.• Inclusion criteria were (i) case series design with more than one case reported, (ii) use of cryoablation or radiofrequency ablation, (iii) patients with renal cell carcinoma and, (iv) outcome reported as clinical effi cacy.• When available, we also quantifi ed the complication rates from each included study.• Proportional meta-analysis was performed on both outcomes with a random-effects model. The 95% confi dential intervals were also calculated. RESULTS• Thirty-one case series (20 cryoablation, 11 radiofrequency ablation) met all inclusion criteria.• The pooled proportion of clinical effi cacy was 89% in cryoablation therapy from a total of 457 cases. There was a statistically signifi cant heterogeneity between these studies showing the inconsistency of clinical and methodological aspects.• The pooled proportion of clinical effi cacy was 90% in radiofrequency ablation therapy from a total of 426 cases. There was no statistically signifi cant heterogeneity between these studies.• There was no statistically signifi cant difference regarding complications rate between cryoablation and radiofrequency ablation. CONCLUSIONS• This review shows that both ablation therapies have similar effi cacy and complication rates.• There is urgency for performing clinical trials with long-term data to establish which intervention is most suitable for the treatment of small renal masses. KEYWORDScryoablation , radiofrequency ablation , small renal tumours , meta-analysis of cases series studies Study Type -Therapy (systematic review)

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Section: Introductionmentioning

confidence: 99%

Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta‐analysis of case series studies

2012

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“…Minimally invasive approaches to urological surgical pathology have become commonplace. Numerous studies show the decreased blood loss, shorter hospital stay and convalescence, and lower patient morbidity of laparoscopy when compared with open surgery [1–6] .…”

Section: Introductionmentioning

confidence: 99%

Surgical complications of laparoscopic urological surgery

Lasser

Ghavamian

2012

Arab Journal of Urology

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ObjectivesTo describe the incidence, identification and management of common intraoperative complications, including vascular, urological, bowel and visceral complications, of laparoscopic urological surgery.MethodsWe searched the databases of PubMed and Medline for relevant English language reports, using the keywords ‘laparoscopy’, ‘urologic’ and ‘complication’.ResultsThe search yielded 967 papers in all, and a review of these yielded a total of 42 relevant papers.ConclusionDespite its advantages, laparoscopic urological surgery is associated with complications having rates as high as 22%. As surgical volumes increase, the incidence and magnitude of complications have increased progressively. Meticulous surgical technique, surgeon experience, and a high degree of suspicion are necessary throughout the surgical endeavour. The intraoperative recognition and management of complications is mandatory.

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“…Of these, 7 underwent open procedures, 5 underwent laparoscopic procedures, and 1 underwent robot-assisted partial nephrectomy. Although it was shown in previous studies that minimally invasive procedures yield better postoperative outcomes in terms of complications for partial nephrectomy [20,21], the number of patients succumbing to significant postoperative bleeding was almost equal between the laparoscopic and the open surgery groups. Further analysis of the patients who developed significant postoperative bleeding would be necessary to explain this unexpected finding.…”

Section: Discussionmentioning

confidence: 82%

Risk Factors for Postoperative Hemorrhage After Partial Nephrectomy

et al. 2014

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PurposeTo evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy.Materials and MethodsThe demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012.ResultsOf the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms.ConclusionsSevere hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients.

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Hand-assisted laparoscopic partial nephrectomy after 60 cases: comparison with open partial nephrectomy

Abstract: HALPN is associated with diminished blood loss, operating time, warm ischemia time, positive margin rates, and length of stay compared with OPN. In our institution, HALPN is the standard approach for patients with small, surgically accessible renal tumors.

Cited by 19 publications

References 22 publications

Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta‐analysis of case series studies

Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta‐analysis of case series studies

Surgical complications of laparoscopic urological surgery

Risk Factors for Postoperative Hemorrhage After Partial Nephrectomy

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